Fillable Form CC-DCM-001 CIVIL - DOMESTIC CASE INFORMATION REPORT (Maryland)

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Form CC-DCM-001 CIVIL - DOMESTIC CASE INFORMATION REPORT (Maryland)

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CIVIL - DOMESTIC CASE INFORMATION REPORT
IN THE CIRCUIT COURT FOR
(City or County)
Plaintiff: This Information Report must be completed and attached to the complaint filed with the Clerk
of Court unless your case is exempted from the requirement by the Chief Judge of the Court of Appeals
pursuant to Rule 2-111(a).
Defendant: You must file an Information Report as required by Rule 2-323(h).
THIS INFORMATION REPORT CANNOT BE ACCEPTED AS A PLEADING
Page 1 of 2CC-DCM-001 (Rev. 04/2017)
DIRECTIONS
PLEADING TYPE
IF NEW CASE: CASE CATEGORY/SUBCATEGORY (Check one box.)
New Case: Original
Existing Case: Post-Judgment Amendment
If filing in an existing case, skip Case Category/ Subcategory section - go to Issues section.
Domestic Family
Agency/IV-D Change of Name
Adoption
Guardianship
Independent Proceedings
Alimony/Spousal Support
Annulment
Breach
Child Support - Private
Custody
Divorce
Family Legal/Medical
Emancipation
Enforce Foreign Order
Paternity/Parentage
Recognition as Legal Child
Visitation
Child Support
Paternity/Parentage
UIFSA
Adoption - Independent
Adoption - Private Agency
Change of Name
Guardianship of Adult Person and/or Property
Guardianship of Minor Person and/or Property
Amend Birth Certificate
Change of Sex
Correct Death Certificate
Declare Deceased
Dispose Body
Amend Marriage Certificate
Adult
Minor
PARTY'S NAME: PHONE:
PARTY'S ADDRESS:
PARTY'S E-MAIL:
PARTY'S ATTORNEY'S NAME: PHONE:
PARTY'S ATTORNEY'S ADDRESS:
PARTY'S ATTORNEY'S E-MAIL:
I am not represented by an attorney
RELATED CASE PENDING? Yes No If yes, Case #(s), if known:
FORM FILED BY: PLAINTIFF DEFENDANT CASE NUMBER
CASE NAME: vs.
Plaintiff
Defendant
(Clerk to insert)
If represented by an attorney:
Spoken Language Interpreter - Attach form CC-DC-041
SPECIAL REQUIREMENTS
If you require an accommodation for a disability under the Americans with Disabilities Act - Attach
form CC-DC-049
Is this case appropriate for referral to an ADR process under Md. Rule 17-101? (Check all that apply)
A. Mediation Yes No C. Settlement Conference Yes No
B. Arbitration Yes No D. Neutral Evaluation Yes No
ALTERNATIVE DISPUTE RESOLUTION INFORMATION
If no, explain why:
Page 2 of 2CC-DCM-001 (Rev. 04/2017)
IF NEW OR EXISTING CASE: ISSUES (Check All that Apply)
Adoption
Alimony/Spousal Support
Permanent
Rehabilitative
Amend Birth Certificate
Amend Death Certificate
Asset Determination
Amend Marriage Certificate
Annulment
Change of Name
Change of Name
Change of Sex
Child Support
Contempt
Court Costs/Fees
Custody
Divorce - Absolute
Declare Deceased
Dispose Body
Divorce - Limited
Earnings Withholding
Emancipation
Enforcement
Exceptions
Family Legal/Medical
Gdnshp of Adult
Person
Person
Gdnshp of Minor
Paternity/Parentage
Pension Distribution
Property Distribution
Protective Order
Register Foreign Order
Restore Former Name
Termination of Gdnshp
Visitation
Transaction Review
Use and Possession
Property
Property
Adult
Minor
Adult
Minor
Time estimate for a Merits Hearing: Hours Days
Time estimate for hearing other than a Merits Hearing: Hours Days
ESTIMATED LENGTH OF HEARING
(Case will be tracked accordingly.)
IS THIS CASE CONTESTED? Yes No If yes, which issues appear to be contested?
Ground for divorce
Child Custody Visitation
Child Support
Alimony Permanent Rehabilitative
Use and possession of family home and property
Marital property issues involving:
Valuation of business Pensions Bank accounts/IRA's Real Property
Other:
Paternity
Adoption/termination of parental rights
Other:
Request is made for: Initial Order Modification Contempt
Absolute Divorce Limited Divorce
For non-custody/visitation issues, do you intend to request:
Court-appointed expert (name field) Initial conference with the Court
Mediation by a Court-sponsored settlement program Other:
For custody/visitation issues, do you intend to request:
Mediation by a private mediator Appointment of counsel to represent child
Evaluation by mental health professional (not just to waive psychiatric privilege)
Other Evaluation A conference with the Court
Is there an allegation of physical or sexual abuse of party or child? Yes No
OTHER MATTERS
Date
Address
Signature of Counsel / Party
Printed Name
City State
Zip Code
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Form CC-DCM-001 CIVIL - DOMESTIC CASE INFORMATION REPORT (Maryland)

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Completed 11 August 2020

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