JS 44 (Rev 09/10)
Civil Cover Sheet Input Form
This form has been approved for use by the general public for generating the civil cover sheet for filing new cases in the Western District of Missouri. Your comments about the form and suggestions for improvements are always greatly appreciated.


Instructions for Completing the Civil Cover Sheet
(PDF)

 



I. Plaintiff, Defendant, and Attorney

ADD FIRST PLAINTIFF AND PLAINTIFF ATTORNEY

Plaintiff(s)
Defendant(s)
Plaintiff Attorney(s)
Defendant Attorney(s) (if known)

II. Case Information

County Where Claim for Relief Arose:

 
 
 
Basis of Jurisdiction:
Origin:
 
Class Action: If an original proceeding, is the case being filed as a Class Action Under FRCP23?
If removed from state court, was the case filed as a Class Action under State statute or rule?
Not filed as a Class Action
 
Cause of Action:

(Cite the U.S. Statute under which you are filing and write a brief statement of cause.
Do not cite jurisdictional statutes unless diversity.)

Related Cases: is not a refiling of a previously dismissed action.
is related to case number , currently pending before Judge .
is a refiling of case number , previously dismissed by Judge .

III. Nature of Suit

Micellaneous Case
999 Micellaneous Case - Use ONLY when filing a misc (MC) case
Administrative Agency
899 Administrative Procedures Act/Review or Appeal of Agency Decision

Agricultural - Title 7 U.S.C.

891 Agricultural Actions (e.g., PACA)
899 Administrative Procedures Act/Review or Appeal of Agency Decision

Arbitration - Title 9 U.S.C.

896 Confirm or Modify Arbitration Award

Banking and Consumer Credit

140 Negotiable Instruments
371 Truth in Lending Act
430 Banks and Banking
480 Fair Credit Reporting Act or Fair Debt Collection Practices Act

Bankruptcy

422 Appeal to District Court
423 Withdrawal of Reference

Business and Commercial

160 Shareholder Derivative Actions
410 Antitrust
450 Interstate Commerce (e.g., Carmack Amendment)
850 Securities, Commodities, Exchanges

Civil Rights - Non Prisoner

441 Voting Rights
442 Employment
443 Housing and Accommodations
445 Americans With Disabilities Act - Employment
446 Americans with Disabilities Act - All Other
448 Education (e.g., IDEA)
440 All Other Civil Rights
Contracts
110 Insurance Contracts
120 Marine Contracts
130 Miller Act
195 Warranties
196 Franchise Agreements
190 All Other Contract Actions
Environmental
893 Environmental Matters
899 Administrative Procedures Act/Review or Appeal of Agency Decision
Forfeiture and Penalty
625 Drug-Related Seizure of Property (21 U.S.C. 881)
690 All Other Forfeiture and Penalty Actions
Fraud and False Claims
370 Fraud Actions
375 False Claims Act (31 U.S.C. 3729)
Freedom of Information Act
895 Freedom of Information Act
Immigration
462 Naturalization Applications
463 Habeas Corpus - Alien Detainee
465 Other Immigration Actions
Intellectual Property
820 Copyright
830 Patent
840 Trademark
Labor
710 Fair Labor Standards Act
720 Labor-Management Relations/Reporting
740 Railway Labor
751 Family and Medical Leave Act
791 ERISA
790 Other Labor Actions
Prisoner Petitions
510 Motion to Vacate Sentence
530 Habeas Corpus
535 Habeas Corpus - Death Penalty
540 Prisoner Petition for Writ of Mandamus
550 Prisoner Civil Rights
555 Prison Conditions
560 Civil Detainee - Conditions of Confinement
Real Property
210 Land Condemnation
220 Foreclosure
230 Rent, Lease, and Ejectment
240 Torts to Land/Real Property Damage
245 Real Property Damage Product Liability
290 Other Real Property Actions
Recovery of Overpayment and Enforcement of Judgments
150 Other Recovery Actions/Enforcement of Judgements
151 Overpayment of Medicare Benefits
152 Defaulted Student Loans
153 Overpayment of Veterans' Benefits
RICO
470 Civil RICO Actions
Social Security Appeals
861 Medicare - HIA (1395ff)
862 Black Lung
863 DWIC/DIWW (405(g))
864 SSID Title XVI
865 RSI (405(g))
FOR SOCIAL SECURITY APPEALS ONLY
If this case seeks review of
an application that was previously
awarded by this court, please enter
the case number:
Tax Suits
870 Tax Suits (U.S. a party)
871 Third Party Tax Suits
Torts
Personal Injury
310 Airplane Personal Injury
320 Assault, Libel, Slander
330 FELA (45 U.S.C. 51)
340 Jones Act/Marine Personal Injury
350 Motor Vehicle Personal Injury
362 Medical Malpractice
360 Other Personal Injury Actions
Personal Injury Product Liability
245 Real Property Damage Product Liability
315 Airplane Product Liability
345 Marine Product Liability
355 Motor Vehicle Product Liability
367 Health Care/Pharmaceutical Product Liability
368 Asbestos Product Liability
365 Other Personal Injury Product Liability
Property Damage
240 Torts to Land/Real Property Damage
245 Real Property Damage Product Liability
380 Personal Property Damage
385 Personal Property Damage Product Liability
Other Statutes
400 State Reapportionment
490 Illegally Accessing Satellite/Cable TV Signals
950 Constitutionality of State Statutes
890 Other Statutory Actions

IV. Signature

Signature of Attorney of Record:         Date:  

NOTE: IMPORTANT - After completion of the civil cover sheet, please attach it as a PDF exhibit to the initiating document (complaint, notice of removal, miscellaneous case initiatiing document) when it is electronically filed.

V. Local Court Modifications

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