CIVIL CASE INFORMATION (WORKSHEET)

(West Virginia Circuit Court — SCA-C-100 intake)

[// GUIDANCE: Use as an intake worksheet; transfer answers to SCA-C-100. Domestic cases use SCA-FC-103. Confirm any county supplements (e.g., business court designations).]

1. CAPTION

text
IN THE CIRCUIT COURT OF [COUNTY] COUNTY, WEST VIRGINIA

[PLAINTIFF NAME], PLAINTIFF
v. CASE 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.
• Defendant phone (if known): [PHONE]

3. ATTORNEY OR SELF-REPRESENTED PARTY

• Name / Bar No.: [ATTORNEY NAME], WV 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 / Debt / Business
• ☐ Debt Collection / Money Owed
• ☐ Contract / Commercial / Business Dispute
• ☐ Insurance / Bad Faith
• ☐ Construction / Lien
• Real Property
• ☐ Quiet Title / Boundary / Easement
• ☐ Foreclosure
• ☐ Landlord/Tenant / Ejectment
• Tort / Personal Injury
• ☐ Motor Vehicle
• ☐ Premises Liability
• ☐ Other Personal Injury / Property Damage
• Products / Professional Liability
• ☐ Products Liability
• ☐ Medical / Professional Liability
• Employment
• ☐ Employment / Wage / Discrimination / Noncompete
• Statutory / Administrative / Appeals
• ☐ Administrative Appeal / Statutory Review
• ☐ Extraordinary Relief / Mandamus / Prohibition
• ☐ Appeal from Magistrate or Other Tribunal
• Other Civil
• ☐ Declaratory / Injunctive / Other Civil: [DESCRIBE]
  [// GUIDANCE: Domestic relations use SCA-FC-103; probate/guardianship use separate forms—do not use this worksheet 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], WV Bar [NUMBER] / Pro Se
Attorney for [PLAINTIFF/DEFENDANT]
[// GUIDANCE: Confirm any county supplements (e.g., arbitration track selection, business court designation, minor-name confidentiality).]