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MOHAVE COUNTY SUPERIOR COURT
CIVIL COVER SHEET
Please provide the following information (Type or Print)
PLAINTIFF’S NAME and ADDRESS:
DEFENDANT’S NAME and ADDRESS:
____________________________________________________
Last
First
Middle
_____________________________________________________
Last
First
Middle
____________________________________________________
Mailing Address
_____________________________________________________
Mailing Address
____________________________________________________
City
State
Zip Code
_____________________________________________________
City
State
Zip Code
____________________________________________________
Social Security Number
Date of Birth
_____________________________________________________
Social Security Number
Date of Birth
(Enter number,press tab to format)
(Use format MM/DD/YYYY)
(Enter number,press tab to format)
(Use format MM/DD/YYYY)
____________________________________________________
Daytime Telephone Number (Enter number, press tab to format)
PLAINTIFF’S ATTORNEY
None
ARBITRATION:
Subject to
Not Subject to
____________________________________________________
Name
State Bar No.
____________________________________________________
Mailing Address
____________________________________________________
City
State
Zip Code
____________________________________________________
Daytime Telephone Number (Enter number, press tab to format)
TYPE OF ACTION
(Place an “X” next to the one description below which best describes the type of case)
TORT MOTOR VEHICLE
TORT NON-MOTOR VEHICLE
MEDICAL MALPRACTICE
CONTRACT
LIMITED JURISDICTION COURT APPEAL
SPECIAL ACTION
NON-CLASSIFIED
______ Forcible Detainer
______ Foreign Judgment
______ Habeas Corpus
______ Change of Name
______ Declaratory Judgment
______ Quiet Title
______ Transcript of Judgment
______ Eminent Domain
______ Restoration of Civil Rights
______ Harassment
______ Seized Property
______ Administrative Review
______ Other: __________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
NOTICE: In order for proper identification, it is necessary that the above requested information be provided at the time of filing your petition/complaint.
DEFENDANT’S NAME and ADDRESS:
DEFENDANT’S NAME and ADDRESS:
___________________________________________________
Last
First
Middle
___________________________________________________
Last
First
Middle
___________________________________________________
Mailing Address
___________________________________________________
Mailing Address
___________________________________________________
City
State
Zip Code
___________________________________________________
City
State
Zip Code
___________________________________________________
Social Security Number
Date of Birth
___________________________________________________
Social Security Number
Date of Birth
(Enter number,press tab to format)
(Use format MM/DD/YYYY)
(Enter number,press tab to format)
(Use format MM/DD/YYYY)
DEFENDANT’S NAME and ADDRESS:
DEFENDANT’S NAME and ADDRESS:
___________________________________________________
Last
First
Middle
___________________________________________________
Last
First
Middle
___________________________________________________
Mailing Address
___________________________________________________
Mailing Address
___________________________________________________
City
State
Zip Code
___________________________________________________
City
State
Zip Code
___________________________________________________
Social Security Number
Date of Birth
___________________________________________________
Social Security Number
Date of Birth
(Enter number,press tab to format)
(Use format MM/DD/YYYY) (Enter number,press tab to format)
(Use format MM/DD/YYYY)
DEFENDANT’S NAME and ADDRESS:
DEFENDANT’S NAME and ADDRESS:
___________________________________________________
Last
First
Middle
___________________________________________________
Last
First
Middle
___________________________________________________
Mailing Address
___________________________________________________
Mailing Address
___________________________________________________
City
State
Zip Code
___________________________________________________
City
State
Zip Code
___________________________________________________
Social Security Number
Date of Birth
___________________________________________________
Social Security Number
Date of Birth
(Enter number,press tab to format)
(Use format MM/DD/YYYY)
(Enter number,press tab to format)
(Use format MM/DD/YYYY)