GENERAL CIVIL CASE COVER SHEET
Supreme Court of the State of New York
County of [COUNTY]
Index No.: _____ (Assigned by Clerk)
[// GUIDANCE: This template is designed for commencement of a civil action in any New York State Supreme Court. It consolidates the data points most county clerks require at filing (or upon purchase of the Index Number) and is intentionally formatted so it can be printed on 8½″ × 11″ paper or uploaded as a fill-able PDF. Bracketed text should be customized for each matter. All section headings required by the REQUEST have been preserved; “N/A” indicates that the heading is not ordinarily applicable to a procedural cover sheet but is included to maintain numbering integrity.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions (Case Information)
IV. Representations & Certifications
V. Covenants & Restrictions — N/A
VI. Default & Remedies — N/A
VII. Risk Allocation — N/A
VIII. Dispute Resolution — N/A
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
A. Title: General Civil Case Cover Sheet
B. Parties: Plaintiff(s): [PARTY NAME(S)]
Defendant(s): [PARTY NAME(S)]
C. Recitals: This Cover Sheet is submitted pursuant to the filing requirements of the Civil Practice Law and Rules, the Uniform Rules for the New York State Trial Courts, and any local rules of the [COUNTY] County Clerk and Supreme Court.
D. Date of Filing: ___ / ___ / 20___
E. Jurisdiction: Supreme Court of the State of New York, County of [COUNTY] (General Original Jurisdiction over civil matters in excess of $25,000).
II. DEFINITIONS
For ease of reference within this Cover Sheet:
1. “Action” means the civil lawsuit commenced by the filing of a Summons and Complaint (or Summons with Notice, Petition, or other initiating paper) together with this Cover Sheet and the statutory Index Number fee.
2. “Counsel of Record” means the attorney(s) whose signature(s) appear in Section X and who have been retained to represent the party(ies) listed.
3. “E-File” or “NYSCEF” means the New York State Courts Electronic Filing System, to the extent mandated or opted into for this Action.
4. “Index Number” means the unique identifier assigned to this Action upon receipt and docketing by the County Clerk.
5. “Nature of Action Code” means the case type designation selected in Section III.C.
III. OPERATIVE PROVISIONS (CASE INFORMATION)
A. Basis of Venue
1. Principal place of business of one or more parties: [_]
2. Location of events or transactions giving rise to the claim: [_]
3. Real property located in county (if applicable): [Address or Tax Map #]
B. Amount in Controversy (select one)
☐ $25,000 – $50,000
☐ $50,001 – $100,000
☐ Over $100,000
☐ Equitable/Declaratory relief only
C. Case Category / Nature of Action (check ONE primary category and ONE sub-category)
1. TORT
☐ Motor Vehicle ☐ Medical Malpractice
☐ Products Liability ☐ Other Negligence
2. CONTRACT
☐ Business Contract ☐ Consumer Credit
☐ Insurance ☐ Real Estate Contract
3. REAL PROPERTY
☐ Mortgage Foreclosure ☐ Partition
☐ Eminent Domain ☐ L/T—Commercial
4. SPECIAL PROCEEDING
☐ CPLR Article 75 (Arbitration)
☐ CPLR Article 78 (Mandamus/Certiorari)
☐ Election Law ☐ Miscellaneous
5. COMMERCIAL DIVISION (if seeking assignment per 22 NYCRR § 202.70)
☐ Breach of Contract ☐ Business Tort
☐ Commercial Insurance Coverage ☐ Other Commercial
6. OTHER
☐ Declaratory Judgment ☐ Enforcement of Judgment
☐ Matrimonial (Supreme Court) ☐ Guardianship
D. Related Cases
1. Prior or pending related actions? ☐ Yes ☐ No
2. If “Yes,” list court, index number, and status: [_______]
E. Mandatory E-Filing Information
1. Is this Action subject to mandatory NYSCEF? ☐ Yes ☐ No
2. If “No,” basis for exemption: ☐ Unrepresented party ☐ Other statutory exemption
F. Filing Fee (to be completed by filer)
• Index Number fee remitted: $ [210.00*]
• Motion/OSC fee (if applicable): $ [45.00]
• RJI fee (if filed with commencement): $ [95.00]
[// GUIDANCE: Insert the current statutory amounts at time of filing; fees are periodically updated by the Legislature and OCA.]
IV. REPRESENTATIONS & CERTIFICATIONS
A. Attorney Certification
The undersigned Counsel of Record hereby certifies, pursuant to 22 NYCRR § 130-1.1-a, that to the best of counsel’s knowledge, information, and belief, formed after an inquiry reasonable under the circumstances:
1. The presentation of this Action is not frivolous; and
2. That proper venue and case classification have been selected.
B. Client Verification (optional)
☐ The plaintiff(s) have reviewed the contents of this Cover Sheet and confirm accuracy.
V. COVENANTS & RESTRICTIONS — N/A
VI. DEFAULT & REMEDIES — N/A
VII. RISK ALLOCATION — N/A
VIII. DISPUTE RESOLUTION — N/A
[// GUIDANCE: Procedural cover sheets do not create enforceable dispute-resolution clauses.]
IX. GENERAL PROVISIONS
A. Amendment
Clerical errors on this Cover Sheet may be corrected by filing an Amended Cover Sheet referencing the original Index Number.
B. Severability
If any section of this Cover Sheet is deemed superfluous by the Clerk, such determination shall not affect the validity of the remaining entries.
C. Integration
This Cover Sheet supplements—but does not replace—any statutorily required forms (e.g., Notice of Commencement of Action Subject to Mandatory E-Filing, Request for Judicial Intervention, Commercial Division Addendum, or Consumer Credit Checklist).
X. EXECUTION BLOCK
Executed on ___ / ___ / 20___
Attorney for Plaintiff(s):
[ATTORNEY NAME], Esq.
[Law Firm Name, if any]
Address: [___]
Telephone: [_] | Email: [_]
NYS Attorney Registration No.: [_]
Signature: ______
(☐ Additional signature blocks for co-counsel and/or multiple plaintiffs attached.)