Court of Common Pleas
Fairfield County, Ohio
______________________________ Case No: ________________
Plaintiff(s)
vs. Judge: ________________
______________________________
Defendant(s)
Civil Filing Categories
Please select which category best describes this action.
☐ Foreclosure ☐ Consumer Action
☐ Other Real Property ☐ Administrative Appeal
☐ Tort Action ☐ Board of Revision
☐ Medical Malpractice ☐ Unemployment
☐ Legal Malpractice ☐ Workers Compensation
☐ Other Malpractice
Is employer self-insured? ☐ Yes ☐ No
☐ Product Liability ☐ Other: _______________________
☐ Personal Injury ☐ Miscellaneous Civil:
☐ Personal Injury- Auto __________________________________
☐ Breach of Contract
Additional Case Information
Has this case been previously filed and dismissed? ☐ Yes ☐ No
If yes, please list previous case number and judge: _______________________
________________________________________________________________
Date of Dismissal Entry or Notice of Dismissal: __________________________
Are there any related cases pending before the court? ☐ Yes ☐ No
If yes, please list case number(s) and assigned judge(s): __________________
________________________________________________________________
Is there a known conflict between any of the parties and the currently assigned judge that may
require a transfer of the case or a visiting judge? ☐ Yes ☐ No
If yes, please explain: ______________________________________________
________________________________________________________________
Plaintiff’s Attorney Information
Name: ______________________________________ Phone: ____________________
Address: ___________________________________________________________________
E-Mail: _____________________________________
