Civil Cover Sheet Input Form (Draft)
This automated civil cover sheet conforms to the manual civil cover sheet approved by the Judicial Conference. This civil cover sheet information must be submitted separately for each civil complaint filed. The clerk of court requires the information to open cases, assign the judge, and prepare required records. The form does not replace, supplement, or affect any pleadings or other paper required by law or rule.


Instructions for Completing the Civil Cover Sheet (PDF)

 

Plaintiff, Defendant, and Attorney

ADD FIRST PLAINTIFF AND PLAINTIFF ATTORNEY

Plaintiff(s)
Defendant(s)
Plaintiff Attorney(s)
Defendant Attorney(s) (if known)

Case Information

County Where Claim for Relief Arose:

 
Check here if you are filing a motion to proceed in forma pauperis.
Does this case challenge the constitutionality of a federal or state statute and neither the U. S., the state, nor their agencies, officers, or employees are parties? (See Fed. R. Civ. P. 5.1) 

NOTE: Do not include cases that only allege that the U. S. or the State of Missouri or any of their agencies have acted unconstitutionally or petitions or complaints filed by persons confined in federal, state, county or municipal penal institutions, jail or mental institutions.
 
Basis of Jurisdiction:
Origin:

 
Class Action: If an original proceeding, is the case being filed as a Class Action Under FRCP23?
If removed from state court, was the case filed as a Class Action under State statute or rule?
Not filed as a Class Action

Demand (Monetary):  		Jury Demand (requested in Complaint):  Yes No
 
Cause of Action (CITE THE U. S. STATUTE UNDER WHICH YOU ARE FILING AND WRITE A BRIEF STATEMENT OF CAUSE. DO NOT CITE JURISDICTIONAL STATUTES UNLESS DIVERSITY.):
 
Related Cases: is not a refiling of a previously dismissed action.
is related to case number , assigned to Judge .
is a refiling of case number , previously dismissed by Judge .

Nature of Suit
Administrative Agency
895 Freedom of Information Act
899 Administrative Procedures Act

Agricultural - Title 7 U.S.C.

891 Agricultural Actions (e.g., PACA)
899 Review or Appeal of Agency Decision

Arbitration - Title 9 U.S.C.

896 Confirm or Modify Arbitration Award

Banking and Consumer Credit

140 Negotiable Instruments
371 Truth in Lending Act
430 Banks and Banking
480 Fair Credit Reporting Act or Fair Debt Collection Practices Act

Bankruptcy

422 Appeal to District Court
423 Withdrawal of Reference

Business and Commercial

160 Shareholder Derivative Actions
410 Antitrust
450 Interstate Commerce (e.g., Carmack Amendment)
850 Securities, Commodities, Exchanges

Civil Rights - Non Prisoner

441 Voting Rights
442 Employment
443 Housing and Accommodations
445 Americans With Disabilities Act - Employment
446 Americans with Disabilities Act - All Other
448 Education (e.g., IDEA)
440 All Other Civil Rights
Contracts
110 Insurance Contracts
120 Marine Contracts
130 Miller Act
195 Warranties
196 Franchise Agreements
190 All Other Contract Actions
Environmental
893 Environmental Matters
899 Review or Appeal of Agency Decision
Forfeiture and Penalty
625 Drug-Related Seizure of Property (21 U.S.C. 881)
690 All Other Forfeiture and Penalty Actions
Fraud and False Claims
370 Fraud Actions
375 False Claims Act (31 U.S.C. 3729)
Freedom of Information Act
895 Freedom of Information Act
Immigration
462 Naturalization Applications
463 Habeas Corpus - Alien Detainee
465 Other Immigration Actions
Intellectual Property
820 Copyright
830 Patent
840 Trademark
Labor
710 Fair Labor Standards Act
720 Labor-Management Relations/Reporting
740 Railway Labor
751 Family and Medical Leave Act
791 ERISA
790 Other Labor Actions
Prisoner Petitions
510 Motion to Vacate Sentence
530 Habeas Corpus
535 Habeas Corpus - Death Penalty
540 Prisoner Petition for Writ of Mandamus
550 Prison Conditions
555 Prisoner Civil Rights
560 Civil Detainee - Conditions of Confinement
Real Property
210 Land Condemnation
220 Foreclosure
230 Rent, Lease, and Ejectment
240 Torts to Land/Real Property Damage
245 Real Property Damage Product Liability
290 Other Real Property Actions
Recovery of Overpayment and Enforcement of Judgments
150 Other Recovery Actions/Enforcement of Judgements
151 Overpayment of Medicare Benefits
152 Defaulted Student Loans
153 Overpayment of Veterans' Benefits
RICO
470 Civil RICO Actions
Social Security Appeals
861 Medicare - HIA (1395ff)
862 Black Lung
863 DWIC/DIWW (405(g))
864 SSID Title XVI
865 RSI (405(g))
Tax Suits
870 Tax Suits (U.S. a party)
871 Third Party Tax Suits
Torts
Personal Injury
310 Airplane Personal Injury
320 Assault, Libel, Slander
330 FELA (45 U.S.C. 51)
340 Jones Act/Marine Personal Injury
350 Motor Vehicle Personal Injury
362 Medical Malpractice
360 Other Personal Injury Actions
Personal Injury Product Liability
245 Real Property Damage Product Liability
315 Airplane Product Liability
345 Marine Product Liability
355 Motor Vehicle Product Liability
367 Health Care/Pharmaceutical Product Liability
368 Asbestos Product Liability
365 Other Personal Injury Product Liability
Property Damage
240 Torts to Land/Real Property Damage
245 Real Property Damage Product Liability
380 Personal Property Damage
385 Personal Property Damage Product Liability
Other Statutes
400 State Reapportionment
490 Illegally Accessing Satellite/Cable TV Signals
950 Constitutionality of State Statutes
890 Other Statutory Actions

Signature

Signature of Attorney of Record:         Date:  

IMPORTANT - The submission of this Civil Cover Sheet does not constitute the filing of your complaint.  You must electronically file your complaint upon notification from the Clerk's Office.

Court-Specific Information