General Civil Case Cover Sheet

GENERAL CIVIL CASE COVER SHEET

Commonwealth of Kentucky — Circuit and District Courts

(AOC Form 104 — Civil Case Cover Sheet (CCCS) — Mandatory for All Civil Filings)

FILING REQUIREMENT NOTICE: Pursuant to Kentucky Supreme Court Order 2021-04, effective January 1, 2021, a completed Civil Case Cover Sheet (AOC Form 104, document code CCCS) is mandatory for all civil case filings in Kentucky Circuit and District Courts. Cases filed in paper format must include a physical cover sheet; cases filed electronically through the Kentucky Court of Justice eFiling system will have the necessary information collected automatically by the system during the filing process. The filer must check the ONE case category that most accurately describes the PRIMARY CASE. If making more than one type of claim, check the one considered most important.

I. COURT AND CASE CAPTION

COMMONWEALTH OF KENTUCKY

CASE CAPTION

II. FILER IDENTITY AND CAPACITY

☐ Attorney for Plaintiff / Petitioner
☐ Attorney for Defendant / Respondent
☐ Self-Represented Plaintiff / Petitioner
☐ Self-Represented Defendant / Respondent
☐ Other (Describe): [________________________________]

III. PARTY INFORMATION

A. Plaintiff(s) / Petitioner(s)

B. Defendant(s) / Respondent(s)

(Use full legal names. Attach a separate sheet labeled "Attachment — Additional Parties" if more space is required.)

IV. ATTORNEY INFORMATION

A. Attorney for Plaintiff / Petitioner

B. Attorney for Defendant / Respondent (if known)

Self-Represented Parties: Insert "Pro Se" in the Attorney Name field and supply personal contact information.

V. CASE TYPE CODES — SELECT ONE PRIMARY CATEGORY

(Per AOC Form 104 and Kentucky Supreme Court Order 2021-04. Check the ONE case category that most accurately describes the PRIMARY CASE. If making more than one type of claim, check the one considered most important.)

A. TORT (INJURY)

☐ A-1 — Auto Accident / Motor Vehicle Collision
☐ A-2 — Premises Liability
☐ A-3 — Product Liability
☐ A-4 — Medical / Professional Malpractice
☐ A-5 — Wrongful Death (KRS 411.130)
☐ A-6 — Other Personal Injury (Describe): [________________________________]
☐ A-7 — Assault / Battery
☐ A-8 — Defamation / Libel / Slander
☐ A-9 — Other Tort (Describe): [________________________________]

B. CONTRACT / COMMERCIAL

☐ B-1 — Breach of Written Contract
☐ B-2 — Breach of Oral Contract
☐ B-3 — Debt Collection / Promissory Note
☐ B-4 — Insurance Coverage / Bad Faith
☐ B-5 — U.C.C. / Commercial (KRS Ch. 355)
☐ B-6 — Construction Contract / Lien
☐ B-7 — Consumer Protection (KRS 367.110 et seq.)
☐ B-8 — Other Contract (Describe): [________________________________]

C. REAL PROPERTY

☐ C-1 — Boundary / Title Dispute
☐ C-2 — Quiet Title / Ejectment (KRS 411.120)
☐ C-3 — Foreclosure (Judicial Foreclosure — KRS 426.005 et seq.)
☐ C-4 — Landlord-Tenant / Forcible Entry and Detainer (KRS 383.200 et seq.)
☐ C-5 — Condemnation / Eminent Domain (KRS 416.540 et seq.)
☐ C-6 — Mechanic's Lien (KRS 376.010 et seq.)
☐ C-7 — Other Real Property (Describe): [________________________________]

D. CIVIL RIGHTS / EMPLOYMENT

☐ D-1 — Employment Discrimination (KRS 344.010 et seq. — Kentucky Civil Rights Act)
☐ D-2 — Retaliation / Whistleblower (KRS 61.101 et seq.)
☐ D-3 — Wage and Hour (KRS 337.010 et seq.)
☐ D-4 — Workers' Compensation Appeal (KRS 342.285)
☐ D-5 — 42 U.S.C. § 1983 (filed in state court)
☐ D-6 — Other Civil Rights / Employment (Describe): [________________________________]

E. DOMESTIC RELATIONS

☐ E-1 — Dissolution of Marriage (KRS 403.140 et seq.)
☐ E-2 — Child Custody / Visitation (KRS 403.270 et seq.)
☐ E-3 — Child Support (KRS 403.211 et seq.)
☐ E-4 — Spousal Support / Maintenance
☐ E-5 — Domestic Violence Order (KRS 403.715 et seq.)
☐ E-6 — Paternity (KRS 406.011 et seq.)
☐ E-7 — Adoption (KRS 199.470 et seq.)
☐ E-8 — Other Domestic Relations (Describe): [________________________________]

F. PROBATE / ESTATE

☐ F-1 — Probate of Will
☐ F-2 — Administration of Estate (KRS 395.010 et seq.)
☐ F-3 — Guardianship / Conservatorship (KRS 387.010 et seq.)
☐ F-4 — Trust Matters (KRS 386B)
☐ F-5 — Other Probate / Estate (Describe): [________________________________]

G. OTHER CIVIL

☐ G-1 — Declaratory Judgment (KRS 418.040 et seq.)
☐ G-2 — Injunctive Relief (CR 65)
☐ G-3 — Administrative Appeal (KRS 13B)
☐ G-4 — Extraordinary Writ — Mandamus / Prohibition / Habeas Corpus
☐ G-5 — Class Action (CR 23)
☐ G-6 — Foreign Judgment Domestication (KRS 426.940 et seq.)
☐ G-7 — Small Claims Appeal
☐ G-8 — Arbitration Award Confirmation / Vacation (KRS 417.050 et seq.)
☐ G-9 — Other Civil (Describe with particularity): [________________________________]

VI. MANNER OF FILING

☐ Initial Complaint / Petition
☐ Counterclaim
☐ Cross-Claim
☐ Third-Party Complaint (CR 14)
☐ Amended Complaint
☐ Supplemental Petition
☐ Other (Describe): [________________________________]

VII. AMOUNT IN CONTROVERSY

(Determines jurisdictional placement between District and Circuit Court)

☐ $0 – $2,500
☐ $2,501 – $5,000
☐ $5,001 – $10,000
☐ $10,001 – $15,000
☐ $15,001 – $50,000
☐ Over $50,000
☐ Non-monetary relief only
☐ Amount not determinable at this time

Exact amount claimed (if liquidated): $ [________________________________]

Jurisdictional Note: Kentucky District Court has jurisdiction over civil matters where the amount in controversy does not exceed $5,000 (KRS 24A.120). Circuit Court has original jurisdiction over all justiciable civil causes not exclusively vested in another court (Ky. Constitution § 112). Effective July 1, 2022, the District Court small claims limit was increased.

VIII. JURY DEMAND

☐ Jury trial demanded pursuant to CR 38
☐ Jury trial NOT demanded at this time

Practice Note: Under CR 38(b), a jury trial demand must be made not later than 10 days after the service of the last pleading directed to the issue upon which a jury is sought. Failure to timely demand a jury constitutes a waiver of the right under CR 38(d).

IX. SERVICE OF PROCESS INFORMATION

A. Method of Service Requested

☐ Personal Service by Sheriff or Constable (CR 4.04(2))
☐ Certified Mail — Return Receipt Requested (CR 4.01)
☐ Warning Order Attorney (CR 4.05 — Defendant's residence unknown)
☐ Service by Publication (CR 4.06)
☐ Service on Secretary of State — Nonresident / Corporate Agent (KRS 454.210)
☐ Waiver of Service / Acceptance of Service (CR 4.04(7))
☐ Other (Describe): [________________________________]

B. Number of Defendants / Respondents to Be Served: [____]

C. Service Address(es)

Note: Under CR 4.01, service of process in Kentucky may be made by certified mail, return receipt requested, as the primary method. Personal service by sheriff or constable is also available under CR 4.04.

X. RELATED OR COMPANION CASES

1. Is any related, re-filed, or companion case presently or previously pending in any Kentucky court or another jurisdiction?

☐ Yes ☐ No

2. If "Yes," list court, case number, and caption:

3. Is consolidation or transfer requested?

☐ Yes ☐ No

XI. FILING FEE SCHEDULE

(Per KRS 23A.205 (Circuit Court) and KRS 24A.170 (District Court). Fee amounts are periodically adjusted by the Administrative Office of the Courts (AOC) and individual counties for local library or technology surcharges.)

Method of Payment:
☐ Cash ☐ Check ☐ Money Order ☐ Certified Check ☐ Credit/Debit Card (via eFiling portal) ☐ eCheck ☐ In Forma Pauperis (IFP — AOC-026)

IFP Filing: If unable to pay, submit a verified motion and affidavit of poverty (AOC Form 026). No fee is due upon court approval.

XII. ELECTRONIC FILING COMPLIANCE

(E-filing is mandatory in most Kentucky circuits. Register at https://kycourts.net.)

☐ This filing is submitted electronically through the Kentucky Court of Justice eFiling system
☐ This filing is submitted in person (paper filing — where permitted)
☐ This filing is submitted by mail (where permitted)

E-Filing Confirmation Number: [________________________________]

Important: When filing electronically, the eFiling system will prompt for the case type and other cover sheet information. Ensure that the information entered in the eFiling system matches this cover sheet. Upload this cover sheet as a separate lead document titled "Civil Case Cover Sheet" (document code CCCS).

XIII. CONFIDENTIAL INFORMATION NOTICE

☐ This filing contains confidential information subject to CR 7.01 or KRS 61.878
☐ A Confidential Information Form (AOC-035 Privacy Redaction Cover Sheet) is attached
☐ No confidential information is included in this filing

Warning: Do NOT include Social Security numbers, complete financial account numbers, or minor children's full names in pleadings or the cover sheet. Use the AOC-035 Privacy Redaction Cover Sheet where necessary.

XIV. CERTIFICATION AND SIGNATURE

I hereby certify that the information provided on this Civil Case Cover Sheet is true and correct to the best of my knowledge and that this filing complies with the Kentucky Rules of Civil Procedure, the Kentucky Revised Statutes, Kentucky Supreme Court Orders 2019-17 and 2021-04, and any applicable local rules.

Electronic Signatures: An electronic signature ("/s/ Name") is acceptable in e-filing counties pursuant to CR 5.02(2).

XV. CLERK'S OFFICE USE ONLY

(Do not write below this line)

XVI. FILING CHECKLIST

☐ Complaint / Petition
☐ This Civil Case Cover Sheet (AOC Form 104 or equivalent)
☐ Summons (one for each defendant — to be issued and signed by Clerk per CR 4)
☐ Filing Fee (per Section XI) or IFP Motion and Affidavit (AOC-026)
☐ Verified Complaint (if required by statute)
☐ Certificate of Merit — Medical Malpractice (if applicable — KRS 411.167)
☐ Privacy Redaction Cover Sheet (AOC-035 — if applicable)
☐ Proposed Scheduling Order (if required by local rule)
☐ Additional Local Forms (if any — check with circuit clerk)

XVII. PRACTICE TIPS FOR KENTUCKY CIVIL FILINGS

1. Venue: Venue for transitory actions is proper in the county where the defendant resides or where the cause of action arose (KRS 452.010 et seq.). Venue for real property actions is in the county where the property is located (KRS 452.010).

2. Statutes of Limitation: The general statute of limitations for personal injury in Kentucky is one year from the date of injury (KRS 413.140(1)(a)). For breach of written contract, 15 years (KRS 413.090(2)). For breach of oral contract, 5 years (KRS 413.120(1)). Medical malpractice must be brought within one year from the date of discovery (KRS 413.140(1)(e)).

3. Medical Malpractice Certificate of Merit: Under KRS 411.167, a medical malpractice complaint must be accompanied by a certificate of merit from a qualified expert.

4. Certified Mail Service: Kentucky's primary method of service is certified mail, return receipt requested, under CR 4.01. This is a distinctive feature of Kentucky practice.

5. Mandatory E-Filing: E-filing is mandatory in most Kentucky circuits. Register at https://kycourts.net and follow the eFiling User Guide available on the Kentucky Court of Justice website.

6. Local Rules: Review any local practice rules for the filing county (often available on the circuit clerk's website) for additional formatting, motion hour procedures, and scheduling orders.

7. Jury Demand Timing: Under CR 38(b), the demand must be filed within 10 days after service of the last pleading on the jury issue. Missing this deadline results in waiver.

8. Poor Person Filing: If the filer cannot afford the filing fee, a verified motion and affidavit (AOC-026) must be filed simultaneously. The court will rule on the request before the case proceeds.

XVIII. SOURCES AND REFERENCES

• Kentucky Supreme Court Order 2019-17 — Authorization for Use of Civil Cover Sheet
• Kentucky Supreme Court Order 2021-04 — Mandatory Civil Cover Sheet (effective January 1, 2021)
• AOC Form 104 — Civil Case Cover Sheet (CCCS) — https://www.kycourts.gov/Legal-Forms/
• Kentucky Revised Statutes (KRS):
• KRS 23A.205 (Circuit Court Clerk Fees)
• KRS 24A.120 (District Court Jurisdiction)
• KRS 24A.170 (District Court Clerk Fees)
• KRS 344.010 et seq. (Kentucky Civil Rights Act)
• KRS 355 (Uniform Commercial Code)
• KRS 367.110 et seq. (Consumer Protection)
• KRS 376.010 et seq. (Mechanic's Liens)
• KRS 383.200 et seq. (Landlord-Tenant)
• KRS 386B (Kentucky Trust Code)
• KRS 403.140 et seq. (Dissolution of Marriage)
• KRS 411.130 (Wrongful Death)
• KRS 411.167 (Medical Malpractice Certificate of Merit)
• KRS 413.090–413.140 (Statutes of Limitation)
• KRS 416.540 et seq. (Condemnation)
• KRS 417.050 et seq. (Arbitration)
• KRS 418.040 et seq. (Declaratory Judgments)
• KRS 426.005 et seq. (Foreclosure)
• KRS 426.940 et seq. (Foreign Judgments)
• KRS 452.010 et seq. (Venue)
• KRS 454.210 (Long-Arm Statute)
• Kentucky Rules of Civil Procedure (CR) 3, 4, 5.02, 7.01, 14, 23, 38, 65
• Kentucky Court of Justice eFiling — https://kycourts.net
• Kentucky Circuit Court Clerks' Manual (February 2026 Edition)

End of Kentucky General Civil Case Cover Sheet Template