GENERAL CIVIL CASE COVER SHEET

State of Tennessee – [☐ Circuit] [☐ Chancery] Court
For the _ Judicial District, _ County

[// GUIDANCE: This template is modeled on the Tennessee Administrative Office of the Courts (AOC) cover-sheet format and may be filed with ANY Tennessee trial-level civil court unless a local rule provides a court-specific form. Check local rules before filing.]

I. CASE IDENTIFICATION

1. Docket No. ________ (Clerk use only)
2. Filing Date: _ / _ / ______
3. Style of Case:
   • Plaintiff(s): _______
   • Defendant(s): ___________
4. Origin of Case (check one):
   ☐ Original Proceeding   ☐ Transferred from Another TN Court   ☐ Remanded from Appellate Court
   ☐ Re-Filed (prior Docket No. ________)

II. PARTY & COUNSEL INFORMATION

[// GUIDANCE: Add additional rows or an attachment if more parties/counsel are involved.]

III. CASE CATEGORY (check ONE primary case type and ALL applicable sub-types)

A. CONTRACT / BUSINESS
☐ Breach of Contract  ☐ Debt Collection  ☐ Consumer Protection  ☐ Construction/Real Estate Contract
☐ Uniform Commercial Code  ☐ Employment Agreement  ☐ Other: ______

B. TORT
☐ Personal Injury  ☐ Wrongful Death  ☐ Medical/Professional Malpractice
☐ Products Liability  ☐ Property Damage  ☐ Defamation  ☐ Other: _____

C. REAL PROPERTY
☐ Detainer / Eviction  ☐ Quiet Title  ☐ Boundary / Easement Dispute  ☐ Lien Enforcement
☐ Condemnation / Eminent Domain  ☐ Other: _____

D. FAMILY / PROBATE (filed outside Domestic Relations Court)
☐ Guardianship  ☐ Conservatorship  ☐ Estate Administration  ☐ Trust Litigation
☐ Other: _______

E. EQUITY / STATUTORY / OTHER CIVIL
☐ Declaratory Judgment  ☐ Injunction  ☐ Administrative Appeal (Tenn. Code Ann. § 4-5-322)
☐ Writ of Certiorari  ☐ Election Contest  ☐ Tax Dispute  ☐ Other: _____

[// GUIDANCE: Only ONE primary category is required for statistical reporting; list secondary issues under “Other.”]

IV. RELIEF SOUGHT

1. Monetary damages sought: $ ________ (exclusive of interest & costs)
2. Non-monetary relief requested (check all that apply):
   ☐ Declaratory  ☐ Injunctive  ☐ Specific Performance  ☐ Other: ______
3. Jury demanded? ☐ Yes  ☐ No   4. Class action? ☐ Yes  ☐ No

V. RELATED CASE DISCLOSURE

1. Are there any pending or closed cases in Tennessee state or federal courts that arise from the same transaction or occurrence?
   ☐ No   ☐ Yes – If yes, list jurisdiction, docket number, style, and status:

[// GUIDANCE: Complete to aid the clerk in appropriate assignment and consolidation.]

VI. FEE SCHEDULE & COST ADVANCE CALCULATION

Statutory filing fees are governed by Tenn. Code Ann. §§ 8-21-401 et seq. and local clerk fee schedules.

A. Base filing fee (civil action) …… $ [LOCAL BASE AMOUNT]
B. Electronic filing surcharge (if applicable) …… $ _
C. Service of process issued by clerk (per summons) x _ @ $ __ = $ _
D. Additional statutory assessments (indigent defense, court technology, etc.) …… $ _
E. TOTAL FEES TENDERED WITH FILING …… $ ________

[// GUIDANCE: Replace bracketed amounts with the current clerk schedule. Many counties publish an itemized PDF. Confirm immediately before filing, as fees change periodically.]

VII. CERTIFICATION & SIGNATURE

I, the undersigned, certify that:

1. The information provided herein is true and accurate to the best of my knowledge, information, and belief, formed after reasonable inquiry;
2. This filing complies with the Tennessee Rules of Civil Procedure, the Tennessee Rules of Professional Conduct, and all applicable local rules; and
3. A copy of this Civil Case Cover Sheet has been or will be served on all other parties as required by Tenn. R. Civ. P. 5.

DATED: _ / _ / ______

[Attorney / Self-Represented Party Signature]

Printed Name: _______
Firm (if any): ______
Address: _____
Phone: ______
Email: ______
TN BPR No.: ______

VIII. CLERK’S ACCEPTANCE (For Office Use Only)

☐ Filing Accepted  ☐ Filing Deficient (see notes)
Date: _ / _ / __  Deputy Clerk: ____
Deficiency Notes/Action Required: _________

PRACTICAL CROSS-CHECK BEFORE FILING

1. Verify the correct venue and style of court (Circuit vs. Chancery).
2. Confirm that all necessary summonses, complaint copies, and fees accompany this sheet.
3. Align the stated “Relief Sought” with the ad damnum clause in the Complaint.
4. If seeking emergency relief (e.g., TRO), file the required separate motion and proposed order.
5. Serve a copy of this Cover Sheet with initial pleadings to expedite judicial assignment.

[// GUIDANCE: In many Tennessee counties, the clerk will reject filings that omit this cover sheet, misstate the fee, or fail to include complete party information. Use this template as part of your routine intake checklist.]