AOC-104

Doc. Code: CCCS

Rev. 12-19 NW
EA L TH OF KE
Case No. ____________________

NT
O
COMM

UCKY
Page 1 of 1 Court ________________________
lex
et
justitia

CO

E
U

C
Commonwealth of Kentucky
RT TI
OF JUS

County ______________________
Court of Justice www.kycourts.gov
CIVIL CASE COVER SHEET Division ______________________

PLAINTIFF/PETITIONER

VS.

DEFENDANT/RESPONDENT

q Check here if YOU DO NOT HAVE AN ATTORNEY and are REPRESENTING YOURSELF
(a Self-Represented [Pro Se] Litigant)

Nature of the Case: Place an "X" to the left of the ONE case category that most accurately describes your
PRIMARY CASE. If you are making more than one type of claim, check the one that you
consider most important.

DOMESTIC RELATIONS TORT (Injury) CONTRACT

q Dissolution/Divorce with Children q Automobile q Automobile Loan

q Dissolution/Divorce without Children q Intentional q Credit Card

q Malpractice-Medical q Buyer Plaintiff
q Paternity
q Malpractice-Other q Fraud
q Custody
_______________________ q Personal Loan
q URESA/UIFSA
q Seller Plaintiff
q Premises Liability
q Visitation/Parenting Time q Other: __________________
q Product Liability
q Voluntary Termination of Parental Rights ________________________
q Property Damage
q Involuntary Termination of Parental Rights
q Slander/Libel/Defamation APPEALS
q Adoption
q Other: __________________ q Appeal from Administrative
q Other: ____________________________ Agency
_______________________
_________________________________ q Appeal from District Court
REAL PROPERTY q Other: __________________
PROBATE / ESTATE q Property Rights ________________________

q Guardianship-Adult q Condemnation
MISC CIVIL
q Guardianship-Juvenile q Forcible Detainer (Eviction) q Habeas Corpus
q Guardianship-Conservatorship q Forcible Entry q Non-Domestic Relations
q Foreclosure Restraining Order
q Probate-Testate (with a will)
q Other: _________________ q Tax
q Probate-Intestate (without a will)
_______________________ q Writs
q Petition to Dispense with Administration q Other: __________________
q Name Change BUSINESS / COMMERCIAL ________________________
q Other: ____________________________ q Business Tort
EMPLOYMENT
_________________________________ q Statutory Action
q Employment-Discrimination
q Business Contract Dispute q Employment-Other
q Other: _________________ ________________________
_______________________ ________________________

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