Form Cc-200 - New Case Information Sheet Page 2
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1
2CC-200.1 V4
COUNTY OF WINNEBAGO
NEW CASE INFORMATION SHEET
Continued
CASE NO.
________________________________
Case Type: ________________________ Total Maximum Claim Amount $____________________
rd
rd
3
Plaintiff: ________________________
3
Defendant: ________________________
Address: ______________________________
Address: ________________________________
City:
_______________________ State: _____
City: _______________________ State: _______
Zip
_________ Tele.# ___________________
Zip __________ Tele.# ____________________
Date of Birth
____________________________
Date of Birth _____________________________
th
th
4
Plaintiff: ________________________
4
Defendant: ________________________
Address: ______________________________
Address: ________________________________
City:
_______________________ State: _____
City: _______________________ State: _______
Zip
_________ Tele.# ___________________
Zip __________ Tele.# ____________________
Date of Birth
____________________________
Date of Birth _____________________________
th
th
5
Plaintiff: ________________________
5
Defendant: ________________________
Address: ______________________________
Address: ________________________________
City:
_______________________ State: _____
City: _______________________ State: _______
Zip
_________ Tele.# ___________________
Zip __________ Tele.# ____________________
Date of Birth
____________________________
Date of Birth _____________________________
th
th
6
Plaintiff: ________________________
6
Defendant: ________________________
Address: ______________________________
Address: ________________________________
City:
_______________________ State: _____
City: _______________________ State: _______
Zip
_________ Tele.# ___________________
Zip __________ Tele.# ____________________
Date of Birth
____________________________
Date of Birth _____________________________
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