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CIVIL COVER SHEET

(Vermont Superior Court — Civil Division Intake Worksheet)

[// GUIDANCE: Use this as an intake worksheet. The official Civil Division cover sheet is filed per V.R.C.P. 3 and V.R.E.F. 4. Confirm any Unit-specific guidance or coding.]

1. CAPTION

text
STATE OF VERMONT
SUPERIOR COURT, CIVIL DIVISION
[UNIT] UNIT

[PLAINTIFF NAME], Plaintiff
v. Docket No.: [TBD BY CLERK]
[DEFENDANT NAME], Defendant

2. PARTY INFORMATION

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

3. ATTORNEY OR SELF-REPRESENTED PARTY

Name / Bar No.: [ATTORNEY NAME], VT Bar [NUMBER]
Firm: [LAW FIRM NAME]
Address: [STREET, CITY, STATE ZIP]
Phone/Email: [PHONE] | [EMAIL]
☐ Self-represented (Pro Se)

4. CASE TYPE (CHECK PRIMARY)

Contract / Business
☐ Debt / Collections / Consumer
☐ Commercial / Business Contract
☐ Insurance / Bad Faith
☐ Construction / Real Estate Contract
Real Property
☐ Quiet Title / Boundary / Easement
☐ Foreclosure / Lien
☐ Landlord/Tenant / Ejectment
Injury / Damage
☐ Motor Vehicle
☐ Premises Liability
☐ Other Personal Injury / Property Damage
☐ Products Liability
☐ Professional Liability (medical/legal/other)
Statutory / Administrative / Appeals
☐ Administrative Appeal / Statutory Review
☐ Rule 75 / Extraordinary Relief
☐ Appeal from Small Claims or Other Tribunal
Equitable / Other Civil
☐ Declaratory / Injunctive / Other Civil: [DESCRIBE]
Local case category/code (if required): [CODE/TEXT]
[// GUIDANCE: Probate and domestic relations matters typically use separate cover sheets; follow the required form for those filings.]

5. AMOUNT IN CONTROVERSY

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

6. JURY DEMAND

☐ Jury requested
☐ Non-jury

7. RELATED CASES

Related case numbers/courts: [LIST OR "NONE"]
Prior appeals/arbitrations: [LIST OR "NONE"]

8. SERVICE & SPECIAL NOTES

Service addresses and method (sheriff/process server/certified mail): [DETAILS]
Interpreter or accommodation needed: [YES/NO - LANGUAGE/ACCOMMODATION]

9. SIGNATURE

text
Date: [DATE]

____________________________________
[ATTORNEY NAME], VT Bar [NUMBER] / Pro Se
Attorney for [PLAINTIFF/DEFENDANT]
[// GUIDANCE: Confirm any county supplements (e.g., arbitration track selection, business court designation, minor-name confidentiality).]

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