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COMMONWEALTH OF PENNSYLVANIA
COURT OF COMMON PLEAS – CIVIL DIVISION
GENERAL CIVIL CASE COVER SHEET
(Pursuant to Pa.R.C.P. No. 205.5)
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[// GUIDANCE: This template is modeled on the statewide form promulgated by the Administrative Office of Pennsylvania Courts (AOPC) and must accompany the initial pleading in every civil action filed in a Pennsylvania Court of Common Pleas.]

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I. DOCUMENT HEADER
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A. Caption & Docket Information
1. County: ____
[PLACEHOLDER: Insert county of filing—e.g., “Philadelphia County.”]
2. Docket No.: ___
[PLACEHOLDER: Leave blank; Prothonotary will assign.]
3. Plaintiff(s): ____
4. Defendant(s): ___

B. Counsel / Pro Se Information
• Name: ____
• Supreme Court I.D. No.: __
• Firm: ____
• Address: ____
• Telephone: _____
• E-Mail: _________

C. Filing Date: _ / _ / ______
Effective upon time-stamping by the Prothonotary of [COUNTY].

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II. DEFINITIONS
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For purposes of this Cover Sheet:

“Action” means the civil proceeding commenced by the filing of the accompanying pleading.
“Case Category” refers to the enumerated subject-matter classifications set forth in Section III.C.
“Prothonotary” means the clerk of the Court of Common Pleas for the county identified in Section I.A.1.
“Filer” means the attorney or self-represented litigant executing the Verification in Section X.

[// GUIDANCE: Add or delete definitions to conform with county-specific practice if necessary.]

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III. OPERATIVE PROVISIONS
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A. Nature of Filing
☐ Initial Complaint
☐ Writ of Summons
☐ Petition
☐ Transfer from Another Jurisdiction (identify): __
☐ Other: __________

B. Amount in Controversy
☐ $ 50,000 or Less
☐ More Than $ 50,000
☐ Arbitration Limits Exceeded (Pa.R.C.P. No. 1301 et seq.)
☐ In Declaratory/Equitable Relief Only

C. Case Category (check ONE most specific category)
1. TORT
☐ Motor Vehicle
☐ Nuisance
☐ Premises Liability
☐ Products Liability
☐ Intentional Tort
☐ Defamation
☐ Professional Liability – Medical
☐ Professional Liability – Other
☐ Other Tort (specify): ____

2. CONTRACT
   ☐ Buyer Plaintiff
   ☐ Debt Collection – Credit Card
   ☐ Debt Collection – Other
   ☐ Employment Dispute – Discrimination
   ☐ Employment Dispute – Other
   ☐ Other Contract (specify): _______

3. REAL PROPERTY
   ☐ Ejectment
   ☐ Eminent Domain
   ☐ Ground Rent
   ☐ Landlord/Tenant Appeal
   ☐ Mortgage Foreclosure – Residential
   ☐ Mortgage Foreclosure – Commercial
   ☐ Quiet Title
   ☐ Other Real Property (specify): ___

4. CIVIL APPEALS
   ☐ Board of Assessment Review
   ☐ Zoning Board
   ☐ Other Statutory Appeal (specify): _____

5. MISCELLANEOUS
   ☐ Declaratory Judgment
   ☐ Mandamus
   ☐ Non-Disclosure Petition
   ☐ Replevin
   ☐ Other Miscellaneous (specify): ___

D. Related Cases, Consolidation, and Coordination
1. Are there any related pending or closed cases in any Pennsylvania court?
☐ Yes (identify docket(s)): ________
☐ No
2. Is consolidation or coordination requested?
☐ Yes ☐ No If “Yes,” attach motion.

E. Jury Demand
☐ Jury of Twelve ☐ Jury of Eight ☐ Non-jury

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IV. REPRESENTATIONS & WARRANTIES
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The Filer represents and warrants that:
1. The information provided herein is true and correct to the best of the Filer’s knowledge, information, and belief formed after reasonable inquiry.
2. No party is a minor or incapacitated person except as specifically noted on the accompanying pleading, and all necessary guardian or parent ad litem appointments have been or will promptly be sought.
3. Venue and subject-matter jurisdiction are proper in the identified Court of Common Pleas.

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V. COVENANTS & RESTRICTIONS
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The Filer covenants to:
1. Promptly notify the Court and all parties of any material change to the information contained herein.
2. Supplement this Cover Sheet if ordered by the Court or required by rule or statute.

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VI. DEFAULT & REMEDIES
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In the event the information provided is incomplete or materially inaccurate, the Court may:
1. Strike or stay the accompanying pleading;
2. Impose sanctions authorized under Pa.R.C.P. Nos. 1023.1-1023.4; and/or
3. Assess appropriate costs and attorney fees.

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VII. RISK ALLOCATION
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Nothing in this Cover Sheet shall expand, limit, or modify any party’s substantive rights or defenses. The filing party assumes the procedural risk associated with any inaccuracies set forth herein.

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VIII. DISPUTE RESOLUTION
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This Cover Sheet is governed by the Pennsylvania Rules of Civil Procedure and the judicial rules of the county identified in Section I.A.1. Any disputes regarding this Cover Sheet shall be resolved by the assigned trial judge or motions court as applicable.

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IX. GENERAL PROVISIONS
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A. Amendment
This Cover Sheet may be amended only in accordance with Pa.R.C.P. No. 1033 or by leave of court.
B. Severability
If any provision herein is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
C. Integration
This Cover Sheet, together with the accompanying initial pleading and any appendices, constitutes the entire filing required by Pa.R.C.P. No. 205.5.

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X. EXECUTION & VERIFICATION
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I, the undersigned Filer, verify that the statements made in this Civil Case Cover Sheet are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. Cons. Stat. § 4904 (unsworn falsification to authorities).

Signature: _____ Date: _ / / __
Name (Printed): ____
Supreme Court I.D. No. (if any): ___

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FILING REQUIREMENTS & FEE SCHEDULE
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1. Filing Requirements
a. This Cover Sheet MUST accompany the initial pleading in all civil actions (Pa.R.C.P. No. 205.5).
b. Two (2) copies shall be provided to the Prothonotary; additional copies must be served on all parties.
c. Failure to submit this Cover Sheet may result in refusal of filing or administrative dismissal.

2. Fee Schedule
   • Initial Filing Fee: $ [PLACEHOLDER – consult county fee schedule]
   • Jury Demand Surcharge: $ [PLACEHOLDER]
   • Miscellaneous Petition Fee: $ [PLACEHOLDER]
   [// GUIDANCE: Insert county-specific amounts; fees vary by county and are periodically adjusted.]

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[// GUIDANCE:
1. Confirm that the categories listed in Section III.C align with the latest AOPC form; update locally if new categories are added.
2. Always check the county’s most recent fee schedule, as Pennsylvania’s unified judicial system sets only baseline fees—each county may impose additional automation or judicial computerization assessments.
3. This Cover Sheet should be printed single-sided on white letter-size (8.5 × 11 inch) paper, with the original signed in blue ink where practicable to distinguish the original in the court file.
4. Some counties require an electronic filing portal “E-Filing Envelope” rather than paper; attach this Cover Sheet as a separate PDF event if e-filing.
5. Verify whether the county requires a separate “Entry of Appearance” form; if so, file concurrently.]