COVER SHEET
STATE OF ARKANSAS
CIRCUIT COURT: DOMESTIC RELATIONS
1
6/1/2017
The domestic relations reporting form and the information contained herein shall not be admissible as
evidence in any other court proceeding or replace or supplement the filing and service of pleadings, orders,
or other papers as required by law of Supreme Court Rule. This form is required pursuant to Administrative
Order Number 8. Instructions are located at www.courts.arkansas.gov.
County: District: Filing Date:
Judge: Division: Case ID:
Type of Case (select only one):
Marriage date:
Doe
s this case involve the custody or support of minor children? Yes No
If yes, also file the completed Confidential Information Sheet.
Plaintiff
Defendant
Last Name
Last Name
Suffix
Suffix
First Name
First Name
DL/State ID
DL/State ID
Address
Address
City, State, ZIP
City, State, ZIP
Phone
Phone
Email
Email
Self-represented
Yes No
Self-represented
Yes No
DOB
DOB
Interpreter
needed?
Yes:
No
Interpreter
needed?
Yes:
No
Atto
rney of Record: Bar #:
For the: Plaintiff Defendant Email Address:
Related Case(s): Judge: Case ID(s):
Manner of filing:
other language:_____________
other language:_______________
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