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Defendant(s) ‐‐ Page 1

CASE INFORMATION AND LITIGANT DATA FORM

CASE NO.__________________________

PARTY INFORMATION

DEFENDANT 1: ( FULL NAME)

DEFENDANT 2: (FULL NAME)

_______________________________________ __

_______________________________________

ALIAS:___________________________________ _______________________________________

PLACE OF BIRTH:__________________________ PLACE OF BIRTH:__________________________

DOB:___/______/_______

DOB:___/______/________

MONTH/DAY/YEAR

MAILING ADDRESS: (Include zip code)

__________________________________________ ______________________________________

PHYSICAL ADDRESS:

_________________________________________ ______________________________________

PLACE OF EMPLOYMENT:

________________________________________ _______________________________________

_______________________________________ _ _______________________________________

EMAIL ADDRESS:

__________________________________________ ______________________________________

HOME TELEPHONE: (____)____________________ (_____)___________________________

CELL NUMBER: (_____)______________________ (_____)___________________________

WORK NO.: __(______)_______________________ (______)___________________________

FAX NO.: _(_______)_________________________ (_____)___________________________

DEFENSE ATTORNEY INFORMATION

CHECK HERE IF APPEARING PRO SE (ON YOUR OWN BEHALF, WITHOUT AN ATTORNEY)

ATTORNEY 1: (FULL NAME)

ATTORNEY 2: (FULL NAME)

_______________________________________

______________________________________

MAILING ADDRESS: (Include zip code)

_________________________________________ ______________________________________

PHYSICAL OFFICE ADDRESS:

Check if Same as Mailing Address

______________________________________

__________________ __________________

______________________________________

____________________________________

______________________________________

____________________________________

Rev. 05/2013

Super. Ct. Form 1‐0001, Part IV

Case Information And Litigant Data Sheet Page 3

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