CIVIL COVER SHEET (JS-44 WORKSHEET)

1. PLAINTIFFS / DEFENDANTS

• Plaintiffs: [LIST NAMES / ADDRESSES]
• Defendants: [LIST NAMES / ADDRESSES]

2. COUNTY OF RESIDENCE

• Plaintiff principal residence: [COUNTY / STATE]
• Defendant principal residence: [COUNTY / STATE]

3. BASIS OF JURISDICTION (CHECK ONE)

• ☐ 1 U.S. Plaintiff ☐ 2 U.S. Defendant ☐ 3 Federal Question ☐ 4 Diversity (complete citizenship below)

4. CITIZENSHIP OF PRINCIPAL PARTIES (DIVERSITY CASES ONLY)

• Plaintiff: ☐1 This State ☐2 Another State ☐3 Foreign State
• Defendant: ☐1 This State ☐2 Another State ☐3 Foreign State

5. NATURE OF SUIT (SELECT CODE)

• Examples: 110 Insurance, 190 Other Contract, 245 Tort Product Liability, 442 Civil Rights, 751 Labor/ERISA, 840 Trademark, 850 Securities/Commodities/Exchange, etc.

6. ORIGIN

• ☐ 1 Original Proceeding ☐ 2 Removed from State Court ☐ 3 Remanded ☐ 4 Reinstated ☐ 5 Transferred ☐ 6 Multidistrict ☐ 8 Multidistrict Appeal ☐ 9 Third or Fourth Party

7. CAUSE OF ACTION

• Statute and brief description: [E.G., 28 U.S.C. §1332; breach of contract]

8. REQUESTED IN COMPLAINT

• ☐ Jury Demand ☐ Non-Jury
• Damages sought: $[AMOUNT] ☐ Class Action under Rule 23
• ☐ TRO/Preliminary Injunction requested

9. RELATED CASE(S)

• List related federal cases, if any: [CASE NO. / JUDGE]

10. ATTORNEY OF RECORD

• Name / Bar No.: [ATTORNEY NAME]
• Firm: [LAW FIRM NAME]
• Address: [ADDRESS]
• Phone/Email: [PHONE] | [EMAIL]

11. SIGNATURE

text
Date: [DATE]

____________________________________
[ATTORNEY NAME]
Attorney for [PLAINTIFF/DEFENDANT]

Local Practice Checklist

• Confirm local rule formatting, page limits, and judge-specific standing orders.
• Use the correct CM/ECF event and include a proposed order when required.
• Verify service requirements and file a certificate of service.