General Civil Case Cover Sheet

West Virginia State Courts

GENERAL CIVIL CASE COVER SHEET

SECTION 1 – CASE IDENTIFICATION

SECTION 2 – PARTY INFORMATION

SECTION 3 – CASE CATEGORY (Check ONE primary category and ONE sub-category)

A. Contract ☐

1. Debt / Collection ☐  2. Construction ☐  3. Insurance ☐  4. Employment Contract ☐  5. Other Contract ☐

B. Torts ☐

1. Personal Injury ☐  2. Wrongful Death ☐  3. Medical Malpractice ☐  4. Product Liability ☐  5. Intentional Tort ☐  6. Defamation ☐  7. Other Tort ☐

C. Real Property ☐

1. Boundary / Title ☐  2. Quiet Title ☐  3. Condemnation / Eminent Domain ☐  4. Landlord–Tenant ☐  5. Other Real Property ☐

D. Civil Rights ☐

1. Discrimination ☐  2. ADA ☐  3. § 1983 / Constitutional ☐  4. Other Civil Rights ☐

E. Business / Commercial ☐

1. Shareholder / Partnership ☐  2. Antitrust ☐  3. Securities ☐  4. Mass Litigation ☐ (attach Mass Litigation Sheet)

F. Other ☐

1. Declaratory Judgment ☐  2. Administrative Appeal ☐  3. Extraordinary Writ ☐  4. Election Contest ☐  5. Foreign Judgment ☐  6. Other (explain): ___________________________

SECTION 4 – RELATED OR COMPANION CASES

1. Are there any related, predecessor, or companion cases involving substantially the same parties or issues?
     Yes ☐  No ☐

2. If YES, list Court, Case No., and disposition status:
     ☐

SECTION 5 – JURY DEMAND / ARBITRATION

| Jury Trial Demanded? | Yes ☐  No ☐ |
| Statutory / Contractual Arbitration Required? | Yes ☐  No ☐ |

SECTION 6 – DAMAGES SOUGHT (check all that apply)

☐ Compensatory   ☐ Punitive   ☐ Injunctive / Declaratory
☐ Attorney Fees   ☐ Pre- & Post-Judgment Interest   ☐ Costs

SECTION 7 – ATTORNEY / PRO SE INFORMATION

If Pro Se, check here ☐ and provide residential address and contact details above.

SECTION 8 – FILING FEE CALCULATION (Circuit Court)

1. Base Filing Fee (civil complaint) | $ [200.00]*
2. Additional Party Fee (# of defendants over two × $[20.00]) | $ ☐
3. Mass Litigation Surcharge (if applicable) | $ ☐
4. Other Statutory Surcharges | $ ☐
   TOTAL REMITTED | $ ☐

Verify current fees with the Clerk; amounts subject to periodic legislative adjustment.

SECTION 9 – CERTIFICATION & SIGNATURE

I hereby certify that:

1. The information provided in this Cover Sheet is true and correct to the best of my knowledge, information, and belief, formed after reasonable inquiry;
2. The Complaint or Petition submitted with this Cover Sheet is filed in good faith and not for the purpose of delay; and
3. All required filing fees and surcharges have been tendered contemporaneously with this filing.

SECTION 10 – CLERK’S OFFICE USE ONLY

END OF COVER SHEET