CIVIL CASE COVER SHEET
(V.R.C.P. 3 & V.R.E.F. 4 COMPLIANT)

[// GUIDANCE: This template is modeled on Vermont Judiciary Form 600 (rev. 2023) and incorporates current statewide filing rules. Replace every bracketed item before filing. Do NOT alter section numbering—internal court processes rely on it.]

Effective Date: [MM/DD/YYYY]

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TABLE OF CONTENTS
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I. Court & Docket Information
II. Party Information & Representation Status
III. Case Type & Statutory Classification
IV. Relief Sought
V. Jury Trial & ADR Election
VI. Related or Companion Cases
VII. Estimated Trial Length
VIII.Fee Calculation & Payment Certification
IX. Definitions (Key Terms Used in This Cover Sheet)
X. Filer Certification & Signature
XI. Clerk’s Office Use Only

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I. COURT & DOCKET INFORMATION
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1.1 Court Unit (County): _____
1.2 Division: Civil
1.3 Docket No.: ____ [// GUIDANCE: Leave blank—Clerk assigns]
1.4 Filing Date: ______

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II. PARTY INFORMATION & REPRESENTATION STATUS
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2.1 PLAINTIFF(S)
a. Name: [PLAINTIFF NAME]
b. Address: [STREET, CITY, STATE, ZIP]
c. Email/Phone: _________
d. Represented By: ☐ Attorney ☐ Self-Represented

If Attorney‐Represented:
i. VT Bar #: ___
ii. Firm Name: __
iii. Address: ___
iv. Email/Phone: __

2.2 DEFENDANT(S)
(Duplicate subsection for each additional defendant)
a. Name: [DEFENDANT NAME]
b. Address: [STREET, CITY, STATE, ZIP]
c. Email/Phone: _________
d. Represented By: ☐ Attorney ☐ Self-Represented

If Attorney‐Represented: (Same info fields as 2.1.d)

[// GUIDANCE: Attach Additional Party Information Sheet if more space is needed.]

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III. CASE TYPE & STATUTORY CLASSIFICATION
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3.1 PRIMARY CASE CATEGORY (Select ONE that best describes the principal cause of action)
☐ Personal Injury / Torts – Auto (PI-AUT)
☐ Personal Injury / Torts – Other (PI-OTH)
☐ Medical Malpractice (MED-MAL)
☐ Product Liability (PRO-LIA)
☐ Wrongful Death (WRN-DEA)
☐ Contract (CON)
☐ Collections (COL)
☐ Foreclosure (FOR)
☐ Real Property – Title/Boundary (REA-TIT)
☐ Real Property – Other (REA-OTH)
☐ Eminent Domain / Condemnation (ED)
☐ Employment (EMP)
☐ Intellectual Property (INT-PRO)
☐ Administrative Appeal (ADM-APP)
☐ Declaratory/Injunctive Relief (DEC-INJ)
☐ Other Civil (CIV-OTH) – Explain: ______

3.2 SECONDARY STATUTES INVOLVED (if any)
[Cite only well-established statutory frameworks, e.g., 9A V.S.A. (UCC) § 1-101, etc.]

[// GUIDANCE: Misclassification may delay docketing. When in doubt, choose “Other Civil” and provide an explanatory note.]

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IV. RELIEF SOUGHT
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4.1 Type of Relief (check all that apply)
☐ Monetary Damages Amount Claimed: $ _
☐ Non-Monetary Relief (describe): _____
☐ Both Monetary & Non-Monetary
☐ Statutory Attorney Fees
☐ Punitive/Exemplary Damages
☐ Declaratory Judgment
☐ Injunction / Specific Performance

4.2 Amount in Controversy (aggregate of all claims): $ ____

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V. JURY TRIAL & ADR ELECTION
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5.1 Jury Demand (Rule 38) ☐ Yes ☐ No
5.2 Binding Arbitration Desired ☐ Yes ☐ No
5.3 Mediation Requested ☐ Yes ☐ No
[// GUIDANCE: Separate stipulation is required for court-sponsored ADR programs.]

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VI. RELATED OR COMPANION CASES
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6.1 Are there related, pending, or previously concluded cases in any VT court?
☐ Yes ☐ No

If YES, provide:
a. Case Name: _____
b. Docket No.: ____
c. Court Unit: ______
d. Nature of Relationship (e.g., same parties, same transaction):

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VII. ESTIMATED TRIAL LENGTH
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7.1 Jury Trial (if demanded): ___ Days
7.2 Bench Trial: ___ Days

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VIII. FEE CALCULATION & PAYMENT CERTIFICATION
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Filing fees are governed by 32 V.S.A. § 1431 and the Vermont Judiciary
“Schedule of Filing Fees.” Current standard fees are provided below for
convenience only; verify at time of filing.

Payment Type: ☐ Check ☐ Money Order ☐ Credit Card Authorization ☐ E-File Account Debit

[// GUIDANCE: Attach the Judiciary’s “Credit Card Authorization Form” or include e-file payment confirmation number if filing electronically.]

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IX. DEFINITIONS
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For purposes of this Cover Sheet:

“Administrative Appeal” means an appeal taken under V.R.C.P. 74 from a
decision of a state or local agency.

“Amount in Controversy” means the total monetary value of all claims for
relief, exclusive of interest and costs, aggregated across all parties on
the same side of the caption.

“Related Case” includes any civil, criminal, probate, family, or
environmental matter involving substantially similar questions of law or
fact such that consolidation might be practicable under V.R.C.P. 42.

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X. FILER CERTIFICATION & SIGNATURE
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I certify that:

1. I have reviewed and completed this Civil Case Cover Sheet in accordance
   with the Vermont Rules of Civil Procedure and the Vermont Rules for
   Electronic Filing;
2. To the best of my knowledge, information, and belief formed after an
   inquiry reasonable under the circumstances, the information set forth
   herein is true, accurate, and complete; and
3. I understand that misrepresentation or material omission may subject me
   to sanctions under V.R.C.P. 11 and applicable professional conduct rules.

Signature: ______ Date: __
Printed Name: _____ Title/Capacity:
VT Bar #: _ (if applicable)

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XI. CLERK’S OFFICE USE ONLY
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☐ Fee Verified ☐ Fee Waiver Petition Attached
☐ Jury Fee Assessed ☐ Case Entered in Odyssey
Data Entry Initials: _ Date: __
Notes: ___________