Fla. R. Civ. P. Form 1.997

The civil cover sheet and the information contained in it neither replace nor

supplement the filing and service of pleadings or other documents as required

by law. This form must be filed by the plaintiff or petitioner with the Clerk of

Court for the purpose of reporting uniform data pursuant to section 25.075,

Florida Statutes. (See instructions for completion.)

I. CASE STYLE

(Name of Court).

Plaintiff Case #

Judge

vs.

Defendant

II. AMOUNT OF CLAIM

Please indicate the estimated amount of the claim, rounded to the

nearest dollar. The estimated amount of the claim is requested for data

collection and clerical processing purposes only. The amount of the claim

shall not be used for any other purpose.

_____ $8,000 or less

_____ $8,001 - $30,000

_____ $30,001- $50,000

_____ $50,001- $75,000

_____ $75,001-$100,000

_____ over $100,000.00

III. TYPE OF CASE (If the case fits more than one type of case,

select the most definitive category.) If the most descriptive label is a

subcategory (is indented under a broader category), place an x on both the

main category and subcategory lines.

CIRCUIT CIVIL

Condominium

Contracts and indebtedness

Eminent domain

Auto negligence

Negligence—other

Business governance

Business torts

Environmental/Toxic tort

Third party indemnification

Construction defect

Mass tort

Negligent security

Nursing home negligence

Premises liability—commercial

Premises liability—residential

Products liability

___ Real property/Mortgage foreclosure

_____ Commercial foreclosure

_____ Homestead residential foreclosure

_____ Non-homestead residential foreclosure

_____ Other real property actions

Professional malpractice

Malpractice—business

Malpractice—medical

Malpractice—other professional

Other

Antitrust/Trade regulation

Business transactions

Constitutional challenge—statute or ordinance

Constitutional challenge—proposed amendment

Corporate trusts

Discrimination—employment or other

Insurance claims

Intellectual property

Libel/Slander

Shareholder derivative action

Securities litigation

Trade secrets

Trust litigation

COUNTY CIVIL

Civil

Real Property/Mortgage foreclosure

Replevins

Evictions

Residential Evictions

______ Non-residential Evictions

Other civil (non-monetary)

IV. REMEDIES SOUGHT (check all that apply):

Monetary;

Nonmonetary declaratory or injunctive relief;

Punitive

V. NUMBER OF CAUSES OF ACTION: []

(Specify)

VI. IS THIS CASE A CLASS ACTION LAWSUIT?

yes

no

VII. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED?

no

yes If “yes,” list all related cases by name, case number, and

court.

VIII. IS JURY TRIAL DEMANDED IN COMPLAINT?

yes

no

IX. DOES THIS CASE INVOLVE ALLEGATIONS OF SEXUAL ABUSE?

yes

no

I CERTIFY that the information I have provided in this cover sheet is accurate

to the best of my knowledge and belief, and that I have read and will comply

with the requirements of Florida Rule of General Practice and Judicial

Administration 2.425.

Signature Fla. Bar #

Attorney or party (Bar # if attorney)

(type or print name) Date

Instructions for Attorneys Completing Civil Cover Sheet

Plaintiff must file this cover sheet with the first document filed in the action or

proceeding (except small claims cases, probate, or family cases). Domestic and

juvenile cases should be accompanied by a completed Florida Family Law

Rules of Procedure Form 12.928, Cover Sheet for Family Court Cases. Failure

to file a civil cover sheet in any civil case other than those excepted above may

result in sanctions.

I. Case Style. Enter the name of the court, the appropriate case number

assigned at the time of filing of the original complaint or petition, the name of

the judge assigned (if applicable), and the name (last, first, middle initial) of

plaintiff(s) and defendant(s).

II. Amount of Claim. Enter the estimated amount of the claim, rounded to

the nearest dollar. The estimated amount of the claim is requested for data

collection and clerical processing purposes only. The amount of the claim shall

not be used for any other purpose.

III. Type of Case. Place an “X” on the appropriate line. If the cause fits more

than one type of case, select the most definitive. If the most definitive label is a

subcategory (indented under a broader category label), place an “X” on the

category and subcategory lines. Definitions of the cases are provided below in

the order they appear on the form.

Circuit Civil

(A) Condominium—all civil lawsuits pursuant to Chapter 718, Florida

Statutes, in which a condominium association is a party.

(B) Contracts and indebtedness—all contract actions relating to

promissory notes and other debts, including those arising from the sale of

goods, but excluding contract disputes involving condominium associations.

(C) Eminent domain—all matters relating to the taking of private

property for public use, including inverse condemnation by state agencies,

political subdivisions, or public service corporations.

(D) Auto negligence—all matters arising out of a party’s allegedly

negligent operation of a motor vehicle.

(E) Negligence—other—all actions sounding in negligence, including

statutory claims for relief on account of death or injury, that are not included

in other main categories.

(F) Business governance—all matters relating to the management,

administration, or control of a company.

(G) Business torts—all matters relating to liability for economic loss

allegedly caused by interference with economic or business relationships.

(H) Environmental/Toxic tort—all matters relating to claims that

violations of environmental regulatory provisions or exposure to a chemical

caused injury or disease.

(I) Third party indemnification—all matters relating to liability

transferred to a third party in a financial relationship.

(J) Construction defect—all civil lawsuits in which damage or injury

was allegedly caused by defects in the construction of a structure.

(K) Mass tort—all matters relating to a civil action involving numerous

plaintiffs against one or more defendants.

(L) Negligent security—all matters involving injury to a person or

property allegedly resulting from insufficient security.

(M) Nursing home negligence—all matters involving injury to a nursing

home resident resulting from negligence of nursing home staff or facilities.

(N) Premises liability—commercial—all matters involving injury to a

person or property allegedly resulting from a defect on the premises of a

commercial property.

(O) Premises liability—residential—all matters involving injury to a

person or property allegedly resulting from a defect on the premises of a

residential property.

(P) Products liability—all matters involving injury to a person or

property allegedly resulting from the manufacture or sale of a defective product

or from a failure to warn.

(Q) Real property/Mortgage foreclosure—all matters relating to the

possession, title, or boundaries of real property. All matters involving

foreclosures or sales of real property, including foreclosures associated with

condominium associations or condominium units. (The amount of claim

specified in Section II. of the form determines the filing fee pursuant to section

28.241, Florida Statutes.)

(R) Commercial foreclosure—all matters relating to the termination of

a business owner’s interest in commercial property by a lender to gain title or

force a sale to satisfy the unpaid debt secured by the property.

(S) Homestead residential foreclosure—all matters relating to the

termination of a residential property owner’s interest by a lender to gain title or

force a sale to satisfy the unpaid debt secured by the property where the

property has been granted a homestead exemption.

(T) Nonhomestead residential foreclosure—all matters relating to the

termination of a residential property owner’s interest by a lender to gain title or

force a sale to satisfy the unpaid debt secured by the property where the

property has not been granted a homestead exemption.

(U) Other real property actions—all matters relating to land, land

improvements, or property rights not involving commercial or residential

foreclosure.

(V) Professional malpractice—all professional malpractice lawsuits.

(W) Malpractice—business—all matters relating to a business’s or

business person’s failure to exercise the degree of care and skill that someone

in the same line of work would use under similar circumstances.

(X) Malpractice—medical—all matters relating to a doctor’s failure to

exercise the degree of care and skill that a physician or surgeon of the same

medical specialty would use under similar circumstances.

(Y) Malpractice—other professional—all matters relating to negligence

of those other than medical or business professionals.

(Z) Other—all civil matters not included in other categories.

(AA) Antitrust/Trade regulation—all matters relating to unfair methods

of competition or unfair or deceptive business acts or practices.

(AB) Business transactions—all matters relating to actions that affect

financial or economic interests.

(AC) Constitutional challenge—statute or ordinance—a challenge to a

statute or ordinance, citing a violation of the Florida Constitution.

(AD) Constitutional challenge—proposed amendment—a challenge to a

legislatively initiated proposed constitutional amendment, but excluding

challenges to a citizen-initiated proposed constitutional amendment because

the Florida Supreme Court has direct jurisdiction of such challenges.

(AE) Corporate trusts—all matters relating to the business activities of

financial services companies or banks acting in a fiduciary capacity for

investors.

(AF) Discrimination—employment or other—all matters relating to

discrimination, including employment, sex, race, age, handicap, harassment,

retaliation, or wages.

(AG) Insurance claims—all matters relating to claims filed with an

insurance company.

(AH) Intellectual property—all matters relating to intangible rights

protecting commercially valuable products of the human intellect.

(AI) Libel/Slander—all matters relating to written, visual, oral, or aural

defamation of character.

(AJ) Shareholder derivative action—all matters relating to actions by a

corporation’s shareholders to protect and benefit all shareholders against

corporate management for improper management.

(AK) Securities litigation—all matters relating to the financial interest or

instruments of a company or corporation.

(AL) Trade secrets—all matters relating to a formula, process, device, or

other business information that is kept confidential to maintain an advantage

over competitors.

(AM) Trust litigation—all civil matters involving guardianships, estates,

or trusts and not appropriately filed in probate proceedings.

County Civil

(AN) Civil – all matters involving claims ranging from $8,001 through

$30,000 in damages, exclusive of interest, costs, and attorney fees.

(AO) Real property/Mortgage foreclosure-all matters involving claims up

to $30,000 relating to the possession, title, or boundaries of real property. All

matters involving foreclosures or sales of real property up to $30,000, including

foreclosures associate with condominium associations or condominium units.

(AP) Replevins—all lawsuits pursuant to Chapter 78, Florida Statutes,

involving claims up to $30,000.

(AQ) Evictions—all matters involving the recovery of possession of

leased land or rental property by process of law.

(AR) Other civil (non-monetary)—includes all other non-monetary

county civil matters that were not described in other county civil categories.

IV. Remedies Sought. Place an “X” on the appropriate line. If more than

one remedy is sought in the complaint or petition, check all that apply.

V. Number of Causes of Action. If the complaint or petition alleges more

than one cause of action, note the number and the name of the cause of action.

VI. Class Action. Place an “X” on the appropriate line.

VII. Related Cases. Place an “X” on the appropriate line.

VIII. Is Jury Trial Demanded In Complaint? Check the appropriate line to

indicate whether a jury trial is being demanded in the complaint.

IX. Sexual Abuse. Plan an “X” on the appropriate line.

ATTORNEY OR PARTY SIGNATURE. Sign the civil cover sheet. Print legibly the

name of the person signing the civil cover sheet. Attorneys must include a

Florida Bar number. Insert the date the civil cover sheet is signed. Signature

is a certification that the filer has provided accurate information on the civil

cover sheet, and has read and complied with the requirements of Florida

Rule of General Practice and Judicial Administration 2.425.