CIVIL CASE REPORTING COVER SHEET WORKSHEET

(Louisiana Civil Case Reporting / Civil Case Cover Sheet shadow – LA. R.S. 13:4688; Rule 9.6)

[// GUIDANCE: Use this to gather data before completing the official Louisiana Civil Case Cover Sheet. It must be submitted with the original petition and is forwarded to the Judicial Administrator.]

1. CAPTION

text
____ JUDICIAL DISTRICT COURT
PARISH OF [PARISH], STATE OF LOUISIANA

Civil Case Reporting / Civil Case Cover Sheet – Worksheet

[PLAINTIFF/PETITIONER NAME], Plaintiff/Petitioner,
v. Suit No.: [TBD BY CLERK]
[DEFENDANT/RESPONDENT NAME], Defendant/Respondent.

2. PARTY INFORMATION

• Plaintiff/Petitioner(s): [NAME / ADDRESS / PHONE / EMAIL]
• Defendant/Respondent(s): [NAME / ADDRESS / PHONE / EMAIL]
• Additional parties: attach list if needed.

3. ATTORNEY OR SELF-REPRESENTED PARTY

• Name / Bar No.: [ATTORNEY NAME], LA Bar [NUMBER] (or “Pro Se”)
• Firm: [LAW FIRM NAME]
• Address: [STREET, CITY, STATE ZIP]
• Phone/Email: [PHONE] | [EMAIL]
• Attorney for: [PLAINTIFF/PETITIONER/DEFENDANT/RESPONDENT]
• [ ] Self-represented party

4. NATURE OF LITIGATION (SELECT PRIMARY)

[// GUIDANCE: Choose the nature of litigation category used on the Louisiana Civil Case Cover Sheet.]
- [ ] Contract / Business / Commercial
- [ ] Tort – motor vehicle
- [ ] Tort – other personal injury/property damage
- [ ] Medical malpractice
- [ ] Legal malpractice
- [ ] Products liability
- [ ] Employment (discrimination, wage, restrictive covenant)
- [ ] Real property / immovable property (quiet title, boundary, possessory)
- [ ] Foreclosure
- [ ] Agency/Administrative appeal
- [ ] Declaratory judgment / injunctive relief
- [ ] Other Civil: [DESCRIBE]

Briefly describe the nature of the litigation: [TEXT]

5. AMOUNT / RELIEF (WORKSHEET)

• Monetary relief: $[AMOUNT] (exclusive of fees/costs)
• Non-monetary / equitable relief: [DESCRIBE]

6. JURY DEMAND

• [ ] Jury requested
• [ ] Non-jury

7. RELATED CASES

• [ ] Yes (list case number(s)/court(s)): [DETAILS]
• [ ] No

8. SERVICE & SPECIAL NOTES (WORKSHEET)

• Service addresses and method (sheriff/process server/certified mail): [DETAILS]
• Interpreter needed: [YES/NO] – Language: [SPECIFY]
• Accommodation needed (ADA/disability): [YES/NO] – Describe: [SPECIFY]

9. CERTIFICATION & SIGNATURE

text
I certify that the information provided is accurate for completion of the Louisiana Civil Case Reporting / Civil Case Cover Sheet.

Date: [DATE]

____________________________________
[ATTORNEY NAME], LA Bar [NUMBER] / Pro Se
Attorney for [PARTY]
[// GUIDANCE: Submit the official Louisiana Civil Case Cover Sheet with the original petition per LA. R.S. 13:4688 and La. Dist. Ct. Rule 9.6; eFiling may collect equivalent data.]***