COVER SHEET Court Identification Docket # Case Year Docket Number
Civil Case Filing Form
(To be completed by Attorney/Party County # Judicial Court ID
Prior to Filing of Pleading) District (CH, CI, CO)
Local Docket ID
Mississippi Supreme Court Form AOC/01 Month Date Year
Administrative Office of Courts (Rev 2016) This area to be completed by clerk Case Number if filed prior to 1/1/94
In the Court of County ― Judicial District
Origin of Suit (Place an "X" in one box only)
Initial Filing Reinstated Foreign Judgment Enrolled Transfer from Other court Other
Remanded Reopened Joining Suit/Action Appeal
Plaintiff ‐ Party(ies) Initially Bringing Suit Should Be Entered First ‐ Enter Additional Plaintiffs on Separate Form
Individual
Last Name First Name Maiden Name, if applicable M.I. Jr/Sr/III/IV
____ Check ( x ) if Individual Plainitiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
____ Check ( x ) if Individual Planitiff is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity
D/B/A or Agency
Business
Enter legal name of business, corporation, partnership, agency ‐ If Corporation, indicate the state where incorporated
____ Check ( x ) if Business Planitiff is filing suit in the name of an entity other than the above, and enter below:
D/B/A
Address of Plaintiff
Attorney (Name & Address) MS Bar No.
____ Check ( x ) if Individual Filing Initial Pleading is NOT an attorney
Signature of Individual Filing:
Defendant ‐ Name of Defendant ‐ Enter Additional Defendants on Separate Form
Individual
Last Name First Name Maiden Name, if applicable M.I. Jr/Sr/III/IV
____ Check ( x ) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
____ Check ( x ) if Individual Defendant is acting in capacity as Business Owner/Operator (d/b/a) or State Agency, and enter entity:
D/B/A or Agency
Business
Enter legal name of business, corporation, partnership, agency ‐ If Corporation, indicate the state where incorporated
____ Check ( x ) if Business Defendant is acting in the name of an entity other than the above, and enter below:
D/B/A
Attorney (Name & Address) ‐ If Known MS Bar No.
( x ) if child support is contemplated
Check
as an issue in this suit.* Alcohol/Drug Commitment
(Voluntary) Real
Property
*If checked, please submit completed Child Support Information Sheet with this Cover Sheet
Other
Adverse Possession
Nature of Suit (Place an "X" in one box only) Children/Minors ‐ Non‐Domestic Ejectment
Domestic Relations Business/Commercial Adoption ‐ Contested Eminent Domain
Child Custody/Visitation Accounting (Business) Adoption ‐ Uncontested Eviction
Child Support Business Dissolution Consent to Abortion
Judicial Foreclosure
Contempt Debt Collection
Minor Removal of Minority Lien Assertion
Divorce:Fault Employment Other _____________________ Partition
Divorce: Irreconcilable Diff. Foreign Judgment Civil Rights
Tax Sale: Confirm/Cancel
Domestic Abuse Garnishment Elections Title Boundary or Easement
Emancipation Replevin Expungement __________________
Other
Modification Other ___________________ Habeas Corpus Torts
Paternity Probate Post Conviction Relief/Prisoner Bad Faith
Property Division Accounting (Probate) Other _____________________ Fraud
Separate Maintenance Birth Certificate Correction Contract
Intentional Tort
Term. of Parental
Rights-Chancery
Mental Health Commitment Breach of Contract Loss of Consortium
UIFSA (eff 7/1/97; formerly URESA) Conservatorship Installment Contract
Malpractice ‐ Legal
Other _____________________ Guardianship Insurance Malpractice ‐ Medical
Appeals Heirship Specific Performance Mass Tort
Administrative Agency Intestate Estate Other _____________________
Negligence ‐ General
County Court Minor's Settlement Statutes/Rules Negligence ‐ Motor Vehicle
Hardship Petition (Driver License) Muniment of Title Bond Validation Premises Liability
Justice Court Name Change Civil Forfeiture Product Liability
MS Dept Employment Security Testate Estate Declaratory Judgment Subrogation
Municipal Court Will Contest Injunction or Restraining Order Wrongful Death
Other _____________________ Alcohol/Drug
Commitment (Involuntary) Other _____________________ Other __________________
IN THE COURT OF COUNTY, MISSISSIPPI
JUDICIAL DISTRICT, CITY OF
Docket No. - Docket No. If Filed
File Yr Chronological No. Clerk’s Local ID Prior to 1/1/94
PLAINTIFFS IN REFERENCED CAUSE - Page 1 of Plaintiffs Pages
IN ADDITION TO PLAINTIFF SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Plaintiff #2:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Plaintiff #3:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Plaintiff #4:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
IN THE COURT OF COUNTY, MISSISSIPPI
JUDICIAL DISTRICT, CITY OF
Docket No. - Docket No. If Filed
File Yr Chronological No. Clerk’s Local ID Prior to 1/1/94
PLAINTIFFS IN REFERENCED CAUSE - Page of Plaintiffs Pages
IN ADDITION TO PLAINTIFF SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Reset Form
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Plaintiff # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Plaintiff is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Plaintiff is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Plaintiff is filing suit in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS PLAINTIFF: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
IN THE COURT OF COUNTY, MISSISSIPPI
JUDICIAL DISTRICT, CITY OF
Docket No. - Docket No. If Filed
File Yr Chronological No. Clerk’s Local ID Prior to 1/1/94
DEFENDANTS IN REFERENCED CAUSE - Page 1 of Defendants Pages
IN ADDITION TO DEFENDANT SHOWN ON CIVIL CASE FILING FORM COVER SHEET
Defendant #2:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Defendant #3:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Defendant #4:
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
IN THE COURT OF COUNTY, MISSISSIPPI
JUDICIAL DISTRICT, CITY OF
Docket No. - Docket No. If Filed
File Yr Chronological No. Clerk’s Local ID Prior to 1/1/94
DEFENDANTS IN REFERENCED CAUSE - Page of Defendants Pages
IN ADDITION TO DEFENDANT SHOWN ON CIVIL CASE FILING FORM COVER SHEET Reset Form
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
Defendant # :
Individual: ( )
Last Name First Name Maiden Name, if Applicable Middle Init. Jr/Sr/III/IV
___Check (T) if Individual Defendant is acting in capacity as Executor(trix) or Administrator(trix) of an Estate, and enter style:
Estate of
___Check (T) if Individual Defendant is acting in capacity as Business Owner/Operator (D/B/A) or State Agency, and enter that name below:
D/B/A
Business
Enter legal name of business, corporation, partnership, agency - If Corporation, indicate state where incorporated
Check (T) if Business Defendant is being sued in the name of an entity other than the name above, and enter below:
D/B/A
ATTORNEY FOR THIS DEFENDANT: Bar # or Name: Pro Hac Vice (T) Not an Attorney(T)
CHILD SUPPORT INFORMATION SHEET
? Please include all information known
IN THE COURT OF COUNTY, MISSISSIPPI
JUDICIAL DISTRICT, CITY OF
Reset Form
Docket No. - Docket No. If Filed
File Yr Chronological No. Clerk’s Local ID Prior to 1/1/94
Father:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone # Drivers License #
Employer Name and Address: ( )
Employer Phone #
Mother:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone # Drivers License #
Employer Name and Address: ( )
Employer Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
Child:
Last First M/I Jr/Sr etc. Date of Birth Social Security #
Address: ( )
Phone #
FOR ADDITIONAL CHILDREN, PLEASE ATTACH ADDITIONAL FORMS
MANDATED PURSUANT TO:
Federal Social Security Act Title IV-D, Information will be sent to the
§§ 454(26)(A) and 454A(e)(4); ADMINISTRATIVE OFFICE OF COURTS AND
Miss. Code Ann. §43-19-31(l)(iii) (Supp. 1999) MDHS CHILD SUPPORT ENFORCEMENT DIVISION
