Court of Common Pleas
Fairfield County, Ohio
______________________________ Case No: ________________
vs. Judge: ________________
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: _____________________________________