Civil Cover Sheet
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7Court of Common Pleas of Philadelphia County
For Prothonotary Use Only (Docket Number)
Trial Division
Civil Cover Sheet
PLAINTIFF'S NAME
DEFENDANT'S NAME
In Re:
PLAINTIFF'S ADDRESS
DEFENDANT'S ADDRESS
PLAINTIFF'S NAME
DEFENDANT'S NAME
PLAINTIFF'S ADDRESS
DEFENDANT'S ADDRESS
PLAINTIFF'S NAME
DEFENDANT'S NAME
PLAINTIFF'S ADDRESS
DEFENDANT'S ADDRESS
TOTAL NO. OF DEFENDANTS
COMMENCEMENT OF ACTION
TOTAL NUMBER OF PLAINTIFFS
X
Complaint
Petition Action
Notice of Appeal
1
0
Writ of Summons
Transfer From Other Jurisdictions
AMOUNT IN CONTROVERSY
COURT PROGRAMS
$50,000.00 or less
Arbitration
Mass Tort
Commerce
Settlement
More than $50,000.00
Jury
Savings Action
Minor Court Appeal
Minors
X
Non-Jury
Petition
Statutory Appeals
W/D/Survival
Other:
CASE TYPE AND CODE (SEE INSTRUCTIONS)
8C NAME CHANGE - ADULT
STATUTORY BASIS FOR CAUSE OF ACTION (SEE INSTRUCTIONS)
RELATED PENDING CASES (LIST BY CASE CAPTION AND DOCKET NUMBER)
IS CASE SUBJECT TO
COORDINATION ORDER?
Yes
No
TO THE PROTHONOTARY:
Kindly enter my appearance on behalf of Plaintiff/Petitioner/Appellant:
Papers may be served at the address set forth below.
NAME OF PLAINTIFF'S/PETITIONER'S/APPELLANT'S ATTORNEY
ADDRESS (SEE INSTRUCTIONS)
PHONE NUMBER
FAX NUMBER
SUPREME COURT IDENTIFICATION NO.
E-MAIL ADDRESS
SIGNATURE
DATE
01-101A
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