Designation Form
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1
2Cleveland Municipal Court
Earle B. Turner, Clerk of Court
Designation Form to be used to indicate the Category of the Case
(Your failure to complete this form may delay the processing of your claim.)
______________________________________________________________________________________________________________________________________________
1. Has this case been previously filed and dismissed? Please check one.
Yes ( )
No ( )
If yes, please indicate court, case number and judge.
Court ______________Case No._______________ Judge________________
2. Are there any related cases, pending or closed?
Please check one.
Yes ( )
No ( )
If yes, please indicate court, case number and judge.
Court ______________Case No._______________ Judge________________
(If more space is necessary, please use the reverse side of this form.)
3. Is this a case under the Consumer Sales Practices Act (O.R.C. 1345.09(E))? Please check one. Yes ( )
No ( )
If yes,
___ Declaratory Judgment; ____ Injunction; _____ Class Action
4. Do you believe that this case can be resolved through Mediation?
Please check one. Yes ( )
No ( )
Plaintiff (include complete name, address and phone #)
Defendant (include complete name, address and phone #)
_____________________________________________
________________________________________________
______________________________________
________________________________________
______________________________________
________________________________________
______________________________________
________________________________________
______________________________________
________________________________________
Phone No.
E-mail address
Phone No.
E-mail address
(If more space is necessary, please use the reverse side of this form.)
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Tort-Motor Vehicle Accident
Forcible Entry and Detainer (Eviction)
-Property Damage
Tort-Motor Vehicle Accident
a. Subject Property Address
-Personal Injury
Tort-Motor Vehicle Accident
Ejectment, Recovery of Real Property
-Prop. Damage & Personal Injury
Tort- vs. Property Owner
a. Subject Property Address
Tort- Product Liability
Marshalling of Lien (foreclosure)
Tort Miscellaneous
a. Subject Property Address
Libel and Slander
Replevin
Contract
Account
Promissory Note
Small Claims
Cognovit
Housing Small Claim
Equity
Other:
If service of process by Certified Mail is returned by the Postal Authorities with an endorsement of “refused” or “unclaimed” the
undersigned waives notice of this by the Clerk and requests ordinary mail service in accordance with Civil Rule 4.6(C) or 4.6(D).
_____________________________________________
Signature of Plaintiff or Attorney for Plaintiff
Attorney Information
__________________________________________
________________________________________
Atty. of Record
(Please Print or Type)
Ohio Supreme Court No.
_______________________________________
_____________________________________
Address
Firm Name
____________________________________________________
_________________________________________________
City
State
Zip Code
Fax Number
(________)_______________________________
_____________________________________
Area Code and Telephone Number
E-Mail Address
case designation sheet rev 03/15
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