Free Civil Case Information Statement - Civil Cases - West Virginia

CIVIL CASE INFORMATION STATEMENT CIVIL CASES
(Other than Domestic Relations)

In the Circuit Court,

County, West Virginia

I. CASE STYLE: Plaintiff(s) Case # Judge:

vs. Defendant(s) Days to Answer Type of Service

Street City, State, Zip

Street City, State, Zip

Street City, State, Zip

Street City, State, Zip Original and
SCA-C100.02 / 1 of 2

copies of complaint enclosed/attached.

PLAINTIFF: DEFENDANT:

CASE NUMBER:

II. TYPE OF CASE:

G G

General Civil Mass Litigation (As defined in T.C.R. Rule XIX (c)

G G G

Adoption Administrative Agency Appeal Civil Appeal from Magistrate Court Miscellaneous Civil Petition Mental Hygiene Guardianship Medical Malpractice

G G G G G G G G G

Asbestos Carpal Tunnel Syndrome Diet Drugs Environmental Industrial Hearing Loss Silicone Implants Other:

G G G G

Habeas Corpus/Other Extraordinary Writ Other:

III.

JURY DEMAND: G Yes G No CASE WILL BE READY FOR TRIAL BY (MONTH/YEAR): _______/_______

IV.

DO YOU OR ANY OF YOUR CLIENTS OR WITNESSES IN THIS CASE REQUIRE SPECIAL ACCOMMODATIONS DUE TO A DISABILITY? G YES G NO IF YES, PLEASE SPECIFY:

G Wheelchair accessible hearing room and other facilities G Interpreter or other auxiliary aid for the hearing impaired G Reader or other auxiliary aid for the visually impaired G Spokesperson or other auxiliary aid for the speech impaired G Other:_______________________________________________________________________

Attorney Name: Firm: Address: Telephone: Dated:

Representing:

G Plaintiff

G Defendant

G Cross-Complainant G Cross-Defendant

Signature

G Proceeding Without an Attorney

SCA-C100.02 / 2 of 2