KANSAS DISTRICT COURTS – GENERAL CIVIL CASE COVER SHEET
(Compliant with Kansas state-wide filing requirements; prepared for immediate attorney customization and clerk submission)

[// GUIDANCE: This template is intended to accompany the initial pleading in any civil action filed in the District Courts of Kansas. It tracks the structure and content prescribed by current statewide administrative orders and local court practices. Always confirm the latest local rule, administrative order, and docket-fee schedule before filing.]

TABLE OF CONTENTS

1. Document Header
2. Definitions (for internal drafting clarity)
3. Case Information Summary
4. Party & Attorney Information
5. Case Category Selection
6. Amount in Controversy & Docket-Fee Calculation
7. Jury Demand & Related Case Disclosures
8. Signature & Certification Block
9. Clerk’s Office Use Only

1. DOCUMENT HEADER

IN THE DISTRICT COURT OF [____] COUNTY, KANSAS
[Civil Department / Division No. __]

Plaintiff(s): [FULL LEGAL NAME(S)] )
)
v. ) Case No. __
)
Defendant(s): [FULL LEGAL NAME(S)] )
Effective Date of Cover Sheet: [DATE]

2. DEFINITIONS

[// GUIDANCE: Definitions appear here solely to aid attorneys in completing the form correctly. They are not part of the final filed cover sheet and may be removed prior to filing.]

“Amount in Controversy” – The total monetary damages, exclusive of costs and interest, claimed by the plaintiff on the face of the initial pleading.
“Case Category” – The primary substantive classification that determines docket-fee assessment and statistical reporting.
“Limited Action” – A civil action in which the Amount in Controversy does not exceed the statutory threshold for streamlined procedure and reduced filing fee.
“Unlimited Civil” – Any civil action exceeding the Limited Action threshold or otherwise not designated as Limited Action.

3. CASE INFORMATION SUMMARY

4. PARTY & ATTORNEY INFORMATION

A. Plaintiff(s)
1. Name: [_]
2. Address: [_]
3. Phone / Email: [____]
4. Attorney (if any): [Name, KS Bar #, Firm, Address, Phone, Email]

B. Defendant(s)
1. Name: [_]
2. Address: [_]
3. Phone / Email: [____]
4. Attorney (if known): [Name, KS Bar #, Firm, Address, Phone, Email]

[// GUIDANCE: For multiple parties, attach Addendum A – Additional Parties using identical formatting.]

5. CASE CATEGORY SELECTION

Select one primary category by marking the corresponding box. (Sub-codes may be required by local practice.)

A. Tort
☐ 01 – Motor Vehicle Personal Injury
☐ 02 – Other Personal Injury (Premises, Product, etc.)
☐ 03 – Wrongful Death

B. Contract
☐ 11 – Breach of Contract
☐ 12 – Consumer Credit / Debt Collection
☐ 13 – Uninsured/Underinsured Motorist

C. Real Property
☐ 21 – Foreclosure
☐ 22 – Quiet Title
☐ 23 – Eminent Domain

D. Statutory / Special Proceedings
☐ 31 – Administrative Appeal
☐ 32 – Declaratory Judgment
☐ 33 – Injunction / Specific Performance

E. Miscellaneous Civil
☐ 41 – Professional Malpractice
☐ 42 – Fraud / Misrepresentation
☐ 43 – Other Civil (Describe): ____

[// GUIDANCE: The above codes mirror statewide statistical categories. If a local administrative order uses different numbering, substitute accordingly.]

6. AMOUNT IN CONTROVERSY & DOCKET-FEE CALCULATION

1. Amount Claimed: $[____]
2. Filing Category (check one):
   ☐ Limited Action – Amount ≤ $[LIMIT]
   ☐ Limited Action – Amount > $[LIMIT] but ≤ $[UPPER LIMIT]
   ☐ Unlimited Civil – Amount > $[UPPER LIMIT] or non-monetary relief
3. Base Docket Fee: $[____]
4. State Surcharge(s): $[____]
5. Technology / Automation Fee: $[____]
6. TOTAL DUE & PAID: $[____]

[// GUIDANCE: Insert the current Kansas docket-fee schedule thresholds (e.g., “$4,000” and “$25,000”) and mandatory surcharges as published by the Judicial Branch. Attach Addendum B – Fee Schedule if local clerk requires a printed schedule.]

7. JURY DEMAND & RELATED CASE DISCLOSURES

A. Jury Demand
☐ Jury trial requested pursuant to K.S.A. Chapter 60.
☐ Jury trial not requested at this time.

B. Related Cases
List any related Kansas state or federal cases (including closed matters) involving substantially the same parties or issues:
1. Case No. [_] – Court: [_] – Status: [_]
2. Case No. [_] – Court: [_] – Status: [_]

8. SIGNATURE & CERTIFICATION BLOCK

I certify that the information provided in this Civil Case Cover Sheet is true and correct to the best of my knowledge, that the selected Case Category accurately reflects the primary subject matter of the complaint or petition, and that the appropriate docket fee has been tendered.

Date: _____

[PRINTED NAME OF ATTORNEY / PRO SE PLAINTIFF]
Kansas Bar No. [_]
Attorney for [Plaintiff / Defendant]
Signature: _______

[// GUIDANCE: If the filer is pro se, substitute “Pro Se Plaintiff” and delete bar-number line.]

9. CLERK’S OFFICE USE ONLY (Do not write below this line)

• Case Number Assigned: ____
• Data Entered in CMS by: _____ Date: ___
• Receipt No. ___ Amount $_

ADDENDUMS (Attach as Necessary)

• Addendum A – Additional Parties
• Addendum B – Detailed Fee Schedule
• Addendum C – Confidential Information Form (if required under local rule)

[// GUIDANCE: Final Checklist for Filing Attorney
1. Confirm all mandatory fields are complete and legible.
2. Verify docket-fee amount with current clerk schedule.
3. Attach pleading, summons(es), and any required confidential-data forms.
4. Provide sufficient copies for clerk service plus one endorsed copy for your records.
5. If filing electronically, upload as a separate “Civil Cover Sheet” document in PDF format.]

This template is drafted for professional use and reflects Kansas-specific filing practice as of the date indicated. Always confirm that no subsequent administrative order or statutory amendment has altered docket-fee amounts, case-category codes, or other filing requirements prior to submission.