UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF MISSOURI

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.

* This application works best with Netscape 6+

This automated JS-44 conforms generally to manual JS-44 approved by the Judicial Conference of the United States in September 1974. The data is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. The information contained herein neither replaces nor supplements the filing and service of pleadings or other papers as required by law. This form is authorized for use only in the Western District of Missouri. Instructions)

I (a) - PLAINTIFFS

DEFENDANTS

b) - County of Residence of First Listed Plaintiff

County of Residence of First Listed Defendant

County Where Claim for Relief Arose

c) Plaintiff's Attorney
Defendant's Attorney (If known)
    Check here if you are filing a motion to proceed in forma pauperis
Does this case seek a declaration judgment that a Missouri statute, rule or regulation is unconstitutional on its face or seek to enjoin the enforcement of a rule or regulation as to all persons because it is unconstitutional on its face? 

NOTE: Do not include cases that only allege that the State of Missouri or any of its agencies have acted unconstitutionally or petitions or complaints filed by persons confined in federal, state, county or municipal penal institutions, jail or mental institutions.
II. Basis of Jurisdiction
(Select from drop menu below)
III. Citizenship of Principal Parties (Diversity cases only)
PLAINTIFF

DEFENDANT
IV. Origin
(Select from drop menu below)
V. Nature of Suit (Select one box)

Contract
110 Insurance
120 Marine
130 Miller Act
140 Negotiable Instrument
150 Recovery of Overpayment & Enforcement of Judgment
151 Medicare Act
152 Student Loan -non VA
153 Recovery of VA Benefits
160 Stockholder Suits
190 Other Contract
195 Contract Product Liability

Real Property
210 Land Condemnation
220 Foreclosure
230 Rent Lease & Ejectment
240 Torts to Land
245 Tort Product Liability
290 Other Real Property

Bankruptcy
422 Appeal 28 USC 158
423 Withdrawal 28 USC 157

Property Rights
820 Copyrights
830 Patent
840 Trademark

Torts

Personal Injury
310 Airplane
315 Airplane Product Liability
320 Assault, Libel & Slander
330 Federal Employers' Liability
340 Marine
345 Marine Product Liability
350 Motor Vehicle
355 Motor Vehicle Product Liability
360 Other Personal Injury

Personal Injury
362 Med. Malpractice
365 Personal Injury - Product Liability
368 Asbestos Personal Injury Product Liability
Personal Property
370 Other Fraud
371 Truth in Lending
380 Other Pers Property Damage
385 Property Damage Product Liability

Immigration
 462 Naturalization Application
463 Habeas Corpus - Alien Detainees
465 Other Immigration Actions

Civil Rights
441 Voting
442 Employment
443 Housing/Accomodations
444 Welfare
440 Other Civil Rights		 Prisoner Petitions
510 Motions to Vacate Sentence
 Habeas Corpus:
530 Habeas Corpus General
535 Habeas Death Penalty
540 Mandamus & Other
550 Civil Rights
555 Prison Condition
Forfeiture/Penalty
610 Agriculture
620 Other Food & Drug
625 Drug Related Seizure of Property 21 USC 881
630 Liquor Laws
640 R.R. & Truck
650 Airline Regulations
660 Occupational Safety/Health
690 Other		 Labor
710 Fair Labor Standards Act
720 Labor/Mgmt. Relations
730 Labor/Mgmt. Reporting & Disclosure Act
740 Railway Labor Act
790 Other Labor Litigation
791 E.R.I.S.A.
Other Statutes
400 State Reapportionment
410 Antitrust
430 Banks & Banking
450 Commerce/ICC Rates/ etc
460 Deportation
470 RICO
810 Selective Service
850 Securities / Commodities / Exchange
875 Customer Challenge 12 USC 3410
891 Agricultural Acts
892 Economic Stabilization Act
893 Environmental Matters
894 Energy Allocation Act
895 Freedom of Information Act
900 Appeal of Fee Determination Under Equal Access to Justice
950 Constitutionality of State Statute
890 Other Statutory Actions

Social Security
861 HIA (1395ff)
862 Black Lung (923)
863 DIWC/DIWW (405(g))
864 SSID Title XVI
865 RSI (405(g))

Federal Tax Suits
870 Taxes US Plaintiff or Defendant
871 IRS Third Party 26 USC 7609
Is this a removal from state court?
VI 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.)
VII. Requested in Complaint Class Action Under FRCP 23
Not Class Action		 Demand
 Jury Demand
(requested in Complaint)
Yes No
VIII. This Case is not a refiling of a previously dismissed action.
 is related to case number , assigned to Judge .
is a refiling of case number , previously dismissed by Judge .

DATE         SIGNATURE OF ATTORNEY OF RECORD 

IMPORTANT - The submission of this Civil Cover Sheet does not constitute the filing of your complaint.  You MUST electronically file your complaint upon notification from the Clerk's Office.