CIVIL ACTION COVER SHEET WORKSHEET
(Massachusetts Superior Court – shadow of the required Civil Action Cover Sheet)
[// GUIDANCE: Use this to gather data before completing the official Superior Court Civil Action Cover Sheet.]
1. CAPTION
text
TRIAL COURT OF MASSACHUSETTS THE SUPERIOR COURT
COUNTY OF [COUNTY]
Civil Action Cover Sheet – Worksheet
Plaintiff(s): [NAME(S)]
Defendant(s): [NAME(S)]
Case No.: [TBD BY CLERK]
2. CASE TYPE IDENTIFICATION
- Code No.: [CODE] Type of Action: [DESCRIPTION]
- Track Designation: [A / F / X / Other per list]
[// GUIDANCE: Use the official case-type list on the MA cover sheet (e.g., A01 Services/Labor/Materials; B03 Motor Vehicle Negligence – Personal Injury; E99 Other Administrative Action).]
3. STATEMENT OF DAMAGES (G.L. c. 212, § 3A)
- Medical expenses to date: $[AMOUNT]
- Future medical expenses: $[AMOUNT]
- Lost wages to date: $[AMOUNT]
- Future lost wages: $[AMOUNT]
- Property damage: $[AMOUNT]
- Other damages (specify): $[AMOUNT] – [DESCRIPTION]
- Total (do not include court costs): $[TOTAL]
4. JURY CLAIM
- [ ] Jury trial claimed
- [ ] Non-jury
5. RELATED ACTIONS
- Related cases/courts/docket numbers (if any): [DETAILS or “None”]
6. PARTIES & COUNSEL
- Plaintiff(s): [NAME / ADDRESS / PHONE / EMAIL]
- Defendant(s): [NAME / ADDRESS / PHONE / EMAIL]
- Additional parties: attach list if needed.
- Attorney: [NAME], MA BBO [NUMBER], Firm: [FIRM], Address: [ADDRESS], Phone: [PHONE], Email: [EMAIL]
- [ ] Self-represented party
7. SERVICE & SPECIAL NOTES (WORKSHEET)
- Service addresses and method: [DETAILS]
- Interpreter needed: [YES/NO] – Language: [SPECIFY]
- Accommodation needed (ADA/disability): [YES/NO] – Describe: [SPECIFY]
8. RULE 1:18 ADR CERTIFICATION (worksheet text)
text
I certify that I have provided my client with information about court-connected dispute resolution services as required by SJC Rule 1:18.
9. SIGNATURE
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Date: [DATE]
____________________________________
[ATTORNEY NAME], MA BBO [NUMBER] / Pro Se
Attorney for [PARTY]
[// GUIDANCE: File the official Civil Action Cover Sheet with the complaint. Ensure Code No., Type of Action, Track, and Statement of Damages are completed per the official form and case-type list.]***