Nature of the Case: Place an “X” to the left of the ONE case category that most accurately describes your
PRIMARY CASE. If you are making more than one type of claim, check the one that
you consider most important.
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CONTRACT (do not include Judgments)
Buyer Plaintiff
Debt Collection: Credit Card
Debt Collection: Other
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Employment Dispute:
Discrimination
Employment Dispute: Other
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Other:
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REAL PROPERTY
Ejectment
Eminent Domain/Condemnation
Ground Rent
Landlord/Tenant Dispute
Mortgage Foreclosure: Residential
Mortgage Foreclosure: Commercial
Partition
Quiet Title
Other:
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CIVIL APPEALS
Administrative Agencies
Board of Assessment
Board of Elections
Dept. of Transportation
Statutory Appeal: Other
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Zoning Board
Other:
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MISCELLANEOUS
Common Law/Statutory Arbitration
Declaratory Judgment
Mandamus
Non-Domestic Relations
Restraining Order
Quo Warranto
Replevin
Other:
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TORT (do not include Mass Tort)
Intentional
Malicious Prosecution
Motor Vehicle
Nuisance
Premises Liability
Product Liability (does not include
mass tort)
Slander/Libel/ Defamation
Other:
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PROFESSIONAL LIABLITY
Dental
Legal
Medical
Other Professional:
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MASS TORT
Asbestos
Tobacco
Toxic Tort - DES
Toxic Tort - Implant
Toxic Waste
Other:
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SupremeCourtofPennsylvania
Court of Common Pleas
Civil Cover Sheet
_______________________________ County
Updated 1/1/2011
For Prothonotary Use Only:
Docket No:
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The information collected on this form is used solely for court administration purposes. This form does not
supplement or replace the filing and service of pleadings or other papers as required by law or rules of court.
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Name of Plaintiff/Appellant’s Attorney: _____________________________________________________________________
Check here if you have no attorney (are a Self-Represented [Pro Se] Litigant)
Commencement of Action:
Complaint Writ of Summons Petition
Transfer from Another Jurisdiction Declaration of Taking
Are money damages requested? Yes No
Is this a Class Action Suit? Yes No Is this an MDJ Appeal? Yes No
Lead Plaintiff’s Name: Lead Defendant’s Name:
Dollar Amount Requested:
(check one)
within arbitration limits
outside arbitration limits
