STATE OF MINNESOTA

DISTRICT COURT – ___ JUDICIAL DISTRICT

GENERAL CIVIL CASE COVER SHEET

(Conforms to Minn. Gen. R. Prac. 104)

[// GUIDANCE: This template follows the structure and substantive requirements of the Minnesota District Court “Civil Cover Sheet” (Form CIV102). Adapt all bracketed fields before filing. Confirm the latest version of required forms, fee amounts, and electronic filing protocols with the Minnesota Judicial Branch or the specific county clerk immediately prior to submission.]

I. CASE IDENTIFICATION

II. PARTY & ATTORNEY INFORMATION

A. Plaintiff(s) / Petitioner(s)
| # | Party Name | Street Address | City / State / ZIP | Telephone | Email |
|---|------------|----------------|--------------------|-----------|-------|
| 1 | [PLAINTIFF 1] | | | | |
| 2 | [Add rows as necessary] |

B. Defendant(s) / Respondent(s)
| # | Party Name | Street Address | City / State / ZIP | Telephone | Email |
|---|------------|----------------|--------------------|-----------|-------|
| 1 | [DEFENDANT 1] | | | | |
| 2 | [Add rows as necessary] |

C. Counsel of Record
| Party Represented | Attorney Name | MN Bar No. | Firm | Address | Telephone | Email |
|-------------------|---------------|------------|------|---------|-----------|-------|
| [e.g., Plaintiff] | [ATTORNEY] | [#######] | [FIRM NAME] | [ADDRESS] | [###-###-####] | [EMAIL] |

[// GUIDANCE: If a party is pro se, list “Self-Represented.” Each attorney must be separately listed and associated with the correct party.]

III. CASE CATEGORY SELECTION

Select the SINGLE primary case category that best describes the action.
(Check one box only.)

1. Contract
   ☐ 101 — Buyer-Seller
   ☐ 102 — Employment
   ☐ 103 — Insurance
   ☐ 199 — Other Contract

2. Personal Injury/Property Damage/Wrongful Death
   ☐ 121 — Motor Vehicle
   ☐ 122 — Premises Liability
   ☐ 123 — Product Liability
   ☐ 124 — Medical/Dental Malpractice
   ☐ 125 — Other Professional Malpractice
   ☐ 129 — Other PI/PD/WD

3. Real Property
   ☐ 141 — Condemnation/Eminent Domain
   ☐ 142 — Mortgage Foreclosure
   ☐ 143 — Mechanic’s Lien
   ☐ 149 — Other Real Property

4. Civil Appeals
   ☐ 181 — District Court
   ☐ 182 — Conciliation Court
   ☐ 183 — State Agency

5. Miscellaneous Civil
   ☐ 191 — Harassment/Restraining Order
   ☐ 192 — Declaratory Judgment
   ☐ 193 — Trust/Probate
   ☐ 194 — Election Contest
   ☐ 199 — Other Civil

[// GUIDANCE: Minnesota’s standardized numeric codes mirror the Minnesota Judicial Branch “Civil Case Type Codes” list. Use the most specific code available. If uncertain, select “Other” within the relevant heading and provide explanatory detail on an attached sheet.]

IV. TRIAL & ALTERNATIVE DISPUTE RESOLUTION (“ADR”)

1. Jury Trial Requested?
   ☐ Yes  ☐ No

2. Estimated Length of Trial: ___ days

3. ADR Election (Minn. Gen. R. Prac. 114):
   ☐ Willing to participate  ☐ Request exemption (attach explanation)

[// GUIDANCE: Most civil cases require participation in an ADR process unless exempted by rule or court order. File the separate “Information Statement for ADR” as required.]

V. FILING FEE CALCULATION

Base Civil Filing Fee (Minn. Stat. § 357.021, subd. 2(1))*  $ [——]
+ Motion/Responsive Pleading Fees (if any) $ [——]
+ Sheriff Service Fees (if prepaid)    $ [——]
= TOTAL DUE           $ [——]

*As of [DATE], the statewide base civil filing fee is $ [CURRENT FEE] but may vary by county surcharge. Verify immediately before filing.

[// GUIDANCE: E-filers must pay by authorized e-Payment method at the time of submission. Paper filers attach a check payable to “District Court Administrator.”]

VI. CERTIFICATION & SIGNATURE

I certify that to the best of my knowledge, information, and belief formed after an inquiry reasonable under the circumstances:

1. This filing is authorized under applicable rules;
2. The information provided above is complete and accurate; and
3. A copy of this cover sheet will be served on all parties along with the initiating pleading, as required by Minn. Gen. R. Prac. 104.

VII. SUBMISSION INSTRUCTIONS

1. Attach to Initial Pleading – File this cover sheet contemporaneously with the Summons & Complaint, Petition, or Notice of Removal.
2. Serve on All Parties – Service must occur no later than service of the first pleading.
3. E-Filing Requirements – All attorneys must e-file via eFS. Self-represented litigants may, but are not required to, e-file.
4. Retention – Maintain a conformed copy for your records in compliance with Minn. R. Civ. P. 11.

[// GUIDANCE: Failure to file and serve a properly completed civil cover sheet may result in court-ordered sanctions, including dismissal of the action or monetary penalties.]

REVISION HISTORY & VERSION CONTROL

• Template Version: 2025-08-07
• Source Authority: Minn. Gen. R. Prac. 104 (2023); Minn. Stat. § 357.021, subd. 2(1) (2023).
[// GUIDANCE: Update statutory fee references annually on July 1 or upon legislative change.]

END OF DOCUMENT