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Maryland Civil Domestic Information Sheet Form

The information reflected in this form allows for the court’s classification of the case filed by the Petitioner.Download

Extracted Text for Proper Search

CIVIL - DOMESTIC CASE INFORMATION REPORT
IN THE CIRCUIT COURT FOR
(City or County)
Plaintiff: This Information Report must be completed and attached to the complaint filed with the Clerk
of Court unless your case is exempted from the requirement by the Chief Judge of the Court of Appeals
pursuant to Rule 2-111(a).
     Defendant: You must file an Information Report as required by Rule 2-323(h).
                           THIS INFORMATION REPORT CANNOT BE ACCEPTED AS A PLEADING
Page 1 of 2
CC-DCM-001 (Rev. 04/2017) DIRECTIONS
PLEADING TYPE

IF NEW CASE: CASE CATEGORY/SUBCATEGORY (Check one box.)
New Case:            Original
Existing Case:         Post-Judgment          Amendment
If filing in an existing case, skip Case Category/ Subcategory section - go to Issues section.
Domestic Family Agency/IV-DChange of Name
Adoption GuardianshipIndependent Proceedings
Alimony/Spousal Support
Annulment
Breach
Child Support - Private
Custody
Divorce
Family Legal/Medical
Emancipation
Enforce Foreign Order
Paternity/Parentage
Recognition as Legal Child
Visitation Child Support
Paternity/Parentage
UIFSA
Adoption - Independent
Adoption - Private Agency Change of Name
Guardianship of Adult Person and/or Property
Guardianship of Minor Person and/or Property Amend Birth Certificate
Change of Sex
Correct Death Certificate
Declare Deceased
Dispose Body
Amend Marriage Certificate
Adult
Minor PARTY'S NAME:                                                                                             PHONE:
PARTY'S ADDRESS:
PARTY'S E-MAIL:

PARTY'S ATTORNEY'S NAME:                                                                     PHONE:
PARTY'S ATTORNEY'S ADDRESS:
PARTY'S ATTORNEY'S E-MAIL:
          I am not represented by an attorney
RELATED CASE PENDING?     Yes     No  If yes, Case #(s), if known:

 FORM FILED BY:     PLAINTIFF       DEFENDANT      CASE NUMBER

CASE NAME:                                                                              vs.




 Plaintiff
Defendant(Clerk to insert)
If represented by an attorney:       Spoken Language Interpreter - Attach form CC-DC-041
 SPECIAL REQUIREMENTS
If you require an accommodation for a disability under the Americans with Disabilities Act - Attach
form CC-DC-049 

  Is this case appropriate for referral to an ADR process under Md. Rule 17-101? (Check all that apply)
  A. Mediation         Yes        No                               C. Settlement Conference          Yes        No
  B. Arbitration        Yes        No                               D. Neutral Evaluation                Yes        No
 ALTERNATIVE DISPUTE RESOLUTION INFORMATION



  If no, explain why:

Page 2 of 2
CC-DCM-001 (Rev. 04/2017) IF NEW OR EXISTING CASE: ISSUES (Check All that Apply)
Adoption
Alimony/Spousal Support
Permanent
Rehabilitative
Amend Birth Certificate Amend Death Certificate
Asset Determination
Amend Marriage Certificate
Annulment
Change of Name Change of Name
Change of Sex
Child Support
Contempt
Court Costs/Fees
Custody
Divorce - Absolute
Declare Deceased
Dispose Body
Divorce - Limited Earnings Withholding
Emancipation
Enforcement
Exceptions
Family Legal/Medical
Gdnshp of Adult
Person
Person
Gdnshp of Minor
Paternity/Parentage Pension Distribution
Property Distribution
Protective Order
Register Foreign Order
Restore Former Name
Termination of Gdnshp
Visitation
Transaction Review
Use and Possession
Property
Property
Adult
Minor Adult
Minor 
 Time estimate for a Merits Hearing:                                                    Hours                       Days
 Time estimate for hearing other than a Merits Hearing:                      Hours                       Days ESTIMATED LENGTH OF HEARING
(Case will be tracked accordingly.) IS THIS CASE CONTESTED?        Yes        No  If yes, which issues appear to be contested?
               Ground for divorce
               Child Custody           Visitation
               Child Support
               Alimony                    Permanent               Rehabilitative
               Use and possession of family home and property
               Marital property issues involving:
                             Valuation of business           Pensions          Bank accounts/IRA's           Real Property
                             Other:
               Paternity
               Adoption/termination of parental rights
               Other: Request is made for:      Initial Order       Modification       Contempt
                                             Absolute Divorce          Limited Divorce For non-custody/visitation issues, do you intend to request:
      Court-appointed expert (name field)                                   Initial conference with the Court
       Mediation by a Court-sponsored settlement program       Other: For custody/visitation issues, do you intend to request:
         Mediation by a private mediator                           Appointment of counsel to represent child
         Evaluation by mental health professional              (not just to waive psychiatric privilege)
         Other Evaluation                                                   A conference with the Court Is there an allegation of physical or sexual abuse of party or child?       Yes       No OTHER MATTERS
Date
Address Signature of Counsel / Party
Printed Name
City StateZip Code
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