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Multiple claims. If a complaint asserts multiple claims which involve different subject matter divisions of the circuit court, the cover sheet for that division which is most definitive of the nature of the case should be selected and completed. COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: DOMESTIC RELATIONS The domestic relations reporting form and the information contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court Rule. This form is required pursuant to Administrative Order Number 8. Instructions are located on the back of the form. FILING INFORMATION District: Docket Number: DR County: Judge: Plaintiff:
Last Name First Name

Division: Defendant:
Last Name

Filing Date:
First Name

Date of Marriage:
Month Day Year

Attorney Providing Information: G Plaintiff G Defendant Address Litigant, if Pro Se:____________________________________________ _____________________________________________________ Address Related Case(s): Judge ________________________________________ Case Number(s) ________________________________________ Type of Case: (Select One) Divorce Divorce w/Support Annulment Separate Maintenance

G G G G G
(CS) (SP) (PT) (PS) Custody/Visitation Child Support Paternity Paternity/Support

IV-D Case (For OCSE use only)

G G G G

(DV) (DS ) (AN ) (SM)

G G G G G

(DA) (FJ) (CT) (BA) (OT)

Domestic Abuse Foreign Judgment Contempt Body Attachment Other_______________________

Manner of Filing:

G Original

G Re-Open

G Transfer

Disposition Date: Decree or Judgment Type: G (JD) Divorce Granted G (OD) Other Decree G (OJ) Other Judgment

DISPOSITION INFORMATION G Bench Trial G Non-Trial G Jury Trial Dismissal Type: Other: G (DW) Dismissed with Prejudice G (TR) Transferred to Another Jurisdiction G (DN) Dismissed without Prejudice

Family Information: G There are no children born of the marriage. G There are children born of the marriage; See Confidential Data AOC Form 35 Public Law 104-193 Information: G ( ) Custody Placed With: G ( ) Child Support G ( ) Spousal Support G ( ) Order of Protection G ( ) Income Withholding

G Plaintiff G New G New G Plaintiff

G Defendant G Modified G Modified G Defendant

G Other (Name) __________________________________ G Terminated G Terminated G Child

Judgment Amount $____________________________

Clerk Signature_______________________________________________ AOC 24 7-05 625 Marshall Street Little Rock AR 72201

Date____________________________________________ Send 1 paper or electronic copy to AOC upon Filing. Send 1 paper or electronic copy to AOC upon Disposition. Keep original in Court file.

Effective 8-12-2005

INSTRUCTIONS FOR COMPLETING DOMESTIC RELATIONS COVER SHEET The domestic relations reporting form and the information contained herein is intended for case assignment and statistical purposes. It shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court Rule. Authority: Supreme Court Administrative Order Number 8. FILING INFORMATION The filing information must be completed by the attorney or pro se litigant filing an initial pleading with the court Clerk. The Clerk shall not accept the pleading unless accompanied by this reporting form. The Clerk shall place the original reporting form in the case file and send a paper or electronic copy of the filing information to the Administrative Office of the Courts in a weekly mailing. Line 1: Fill in the blanks for County and Judicial District where this pleading is being filed. Unless this is a re-open case, the Clerk will assign you the docket number to fill in that blank. Line 2: Fill in the blanks for Judge's name and division (if applicable). In a multi-judge county, the Clerk will tell you the correct Name and Division or will complete this information. The Filing Date is the month, day, and year you are filing this pleading. Line 3 - 4: Fill in the blanks for the Plaintiff and Defendant names as they appear in the style of the pleading you are filing and enter the last name and then the first name. Fill in the date of marriage on the appropriate line. Lines 5 - 7: Fill in the name and address of the attorney providing the information and check the appropriate box of the party the attorney is representing. If you are a Pro Se litigant please complete that information. "Pro Se" means you are filing this pleading on your own behalf and are not represented by an attorney. Line 8: Reference any related case(s). Type of Case: Place an "X" in the single box which best describes the subject matter of the pleading you are filing. If no Type accurately describes the subject matter, place an "X" in the box for Other and specify the type of filing in the blank. (DV)=Divorce without support issues. (DS)=Divorce with child or spousal support. (CS)=Modification of either custody or visitation. (SP)= Modification of child support. (PT)= Paternity without support issues. (PS)=Paternity with support. Manner of Filing: Place an "X" in the appropriate box. For the purposes of this reporting form, the following definitions apply. "Original" means a filing of a complaint or petition at the beginning of a case. "Re-open" means a case which has been disposed of but is now being resubmitted to the court. For example, the plaintiff and defendant have divorced each other, and the subject of this pleading is a change of custody or modification of child support. "Transfer" means a case filed with this court from another court due to invalid jurisdiction, venue, etc. A form should not be completed when enforcing a judgment, e.g. contempt motion. DISPOSITION INFORMATION When the final order/decree/judgment is presented for filing with the Clerk, the Clerk or other official as the trial court may designate, shall complete the following disposition information on the reporting form which was placed in the case file when the initial pleading was filed. The order shall not be filed unless the Disposition Information is completed. Disposition Date: This is the month, day, and year of the Clerk's date stamp. Place an "X" in the appropriate box for type of trial. For the purposes of this reporting form the following definitions apply. A "Bench Trial" is a trial in which there is no jury and in which a judge determines both the issue of fact and law in a case. A "Non-Trial" is where a case is disposed of by one of the following methods: a) a settlement by agreement of the parties; b) an order of dismissal; c) an order granted prior to the trial which concludes the case; d) the defendant did not respond to the allegations contained in the complaint, e.g., an uncontested divorce. Decree or Judgment Type: Place an "X" in the box which best describes the type of final order/decree/judgment that is being filed. Dismissal Type/Other: Place an "X" in the box which describes the manner of disposition. Family Information: Place an "X" in the appropriate box. If there are children born of the marriage see Confidential Data AOC Form (35). Public Law 104-193 Information: Effective 10-98, Public Law 104-193 requires this information in all cases involving support. Place an "X" in each box that applies. Order of Protection information should identify the party(ies) being protected. Judgment Amount: If applicable, fill in the dollar amount granted. Fees and costs are not included. The Clerk or a Deputy Clerk shall sign on the signature line. A Clerk's signature stamp will suffice. The date is the same as the Disposition Date. The clerk shall retain the original reporting form in the case file and shall send a paper or electronic copy of the completed form to the Administrative Office of the Courts in a weekly mailing.

07-07-2006