General Civil and Domestic Relations Case Filing Information Form
Superior or ☐ State Court of ______________________________ County
☐
GWINNETT
For Clerk Use Only
Date Filed _________________________
Case Number _________________________
MM-DD-YYYY
Plaintiff(s)
Defendant(s)
__________________________________________________
__________________________________________________
GA Dept. of Public Health/Office of Vital Records
Last
First
Middle I.
Suffix
Prefix
Last
First
Middle I.
Suffix
Prefix
__________________________________________________
__________________________________________________
Last
First
Middle I.
Suffix
Prefix
Last
First
Middle I.
Suffix
Prefix
__________________________________________________
__________________________________________________
Last
First
Middle I.
Suffix
Prefix
Last
First
Middle I.
Suffix
Prefix
__________________________________________________
__________________________________________________
Last
First
Middle I.
Suffix
Prefix
Last
First
Middle I.
Suffix
Prefix
Plaintiff’s Attorney ________________________________________
Bar Number __________________
Self-Represented ☐
Check One Case Type in One Box
General Civil Cases
Domestic Relations Cases
Automobile Tort
Adoption
☐
☐
Civil Appeal
Dissolution/Divorce/Separate
☐
☐
Contract
Maintenance
☐
Garnishment
Family Violence Petition
☐
☐
Paternity/Legitimation
General Tort
☐
☐
Support – IV-D
Habeas Corpus
☐
☐
Injunction/Mandamus/Other Writ
Support – Private (non-IV-D)
☐
☐
Other Domestic Relations
Landlord/Tenant
☐
☐
Medical Malpractice Tort
☐
Product Liability Tort
Post-Judgment – Check One Case Type
☐
Real Property
☐
Contempt
☐
Restraining Petition
☐
Non-payment of child support,
☐
Other General Civil
☐
medical support, or alimony
Modification
☐
Other/Administrative
☐
Check if the action is related to another action(s) pending or previously pending in this court involving some or all
☐
of the same parties, subject matter, or factual issues. If so, provide a case number for each.
____________________________________________
____________________________________________
Case Number
Case Number
I hereby certify that the documents in this filing, including attachments and exhibits, satisfy the requirements for
☐
redaction of personal or confidential information in O.C.G.A. § 9-11-7.1.
Is an interpreter needed in this case? If so, provide the language(s) required. ________________________________
☐
Language(s) Required
Do you or your client need any disability accommodations? If so, please describe the accommodation request.
☐
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Version 1.1.18