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Here is the text we could read:

MP 

A

ST

 
E

 

T
I
M

or Prothonotary Use Only:  

ocket No: 

  F

  D

Supreme Court of Pennsylvania 

 

Court of Common Pleas  
Civil Cover Sheet 

 

 

_______________________________ County 

The information collected on this form is used solely for court administration purposes.  This form does not 
supplement or replace the filing and service of pleadings or other papers as required by law or rules of court.   

Commencement of Action: 
   (cid:134)  Complaint            (cid:134)  Writ of Summons           
   (cid:134)  Transfer from Another Jurisdiction 
 

         

(cid:134)  Petition            
(cid:134)  Declaration of Taking 

 

 

Lead Plaintiff’s Name: 
 

 

 

 

 

          Lead Defendant’s Name:  

 Are money damages requested?  (cid:134) Yes 

  (cid:134)  No                 

 Dollar Amount Requested: 
(check one) 

 (cid:133) within arbitration limits 
 (cid:133) outside arbitration limits 

  Is this a Class Action Suit?           (cid:134) Yes 

  (cid:134)  No 

Is this an MDJ Appeal?        (cid:133)  Yes     (cid:133)  No 

S 
E 
C 
T  
I  
O 
N 

 

  A

   

   

         Name of Plaintiff/Appellant’s Attorney: _____________________________________________________________________        

      (cid:134) Check here if you have no attorney (are 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. 

CIVIL APPEALS 
   Administrative Agencies 
    (cid:134)  Board of Assessment 
    (cid:134)  Board of Elections 
    (cid:134)  Dept. of Transportation   
    (cid:134)  Statutory Appeal: Other    
          _________________________ 
          _________________________ 

   (cid:134)  Zoning Board 
     
    (cid:134)  Other:   
          _________________________ 
          _________________________              

CONTRACT (do not include Judgments) 
    (cid:134)  Buyer Plaintiff 
    (cid:134)  Debt Collection: Credit Card 
    (cid:134)  Debt Collection: Other 
          ________________________ 
          ________________________ 

   

   (cid:134)  Employment Dispute: 
          Discrimination 
    (cid:134)  Employment Dispute: Other  
           ________________________ 
           ________________________ 
            
     
    (cid:134)  Other:   
          ________________________ 
          ________________________           

   

REAL PROPERTY 
    (cid:134)  Ejectment 
    (cid:134)  Eminent Domain/Condemnation 
    (cid:134)  Ground Rent 
    (cid:134)  Landlord/Tenant Dispute  
    (cid:134)  Mortgage Foreclosure: Residential 
    (cid:133)  Mortgage Foreclosure: Commercial 
    (cid:134)  Partition 
    (cid:134)  Quiet Title                  
    (cid:134)  Other:  
          ________________________ 
          ________________________ 
 

MISCELLANEOUS 
    (cid:134)  Common Law/Statutory Arbitration  
    (cid:134)  Declaratory Judgment 
    (cid:134)  Mandamus 
    (cid:134)  Non-Domestic Relations                               
          Restraining Order 
    (cid:134)  Quo Warranto 
    (cid:134)  Replevin 
    (cid:134)  Other:   
          _________________________ 
          _________________________ 

 

Updated 1/1/2011 

TORT (do not include Mass Tort) 
    (cid:134)  Intentional 
    (cid:134)  Malicious Prosecution 
    (cid:134)  Motor Vehicle 
    (cid:134)  Nuisance 
    (cid:134)  Premises Liability     
    (cid:134)  Product Liability (does not include    
         mass tort) 
    (cid:134)  Slander/Libel/ Defamation 
    (cid:134)  Other:  
          _________________________ 
          _________________________ 

MASS TORT 
    (cid:134)  Asbestos 
    (cid:134)  Tobacco 
    (cid:134)  Toxic Tort - DES 
    (cid:134)  Toxic Tort - Implant 
    (cid:134)  Toxic Waste 
    (cid:134)  Other:   
          _________________________ 
          _________________________           

S 

E C T

 
I 

 

O N

   

 B 

PROFESSIONAL LIABLITY 
    (cid:134)  Dental 
    (cid:134)  Legal 
    (cid:134)  Medical 
    (cid:134)  Other Professional: 
          _________________________ 
          _________________________                   

 

(i) 

actions pursuant to the Protection from Abuse Act, Rules 1901 et seq. 

(ii) 

actions for support, Rules 1910.1 et seq. 

(iii) 

actions for custody, partial custody and visitation of minor children, Rules 

(iv) 

actions for divorce or annulment of marriage, Rules 1920.1 et seq. 

(v) 

actions in domestic relations generally, including paternity actions, Rules 

NOTICE 

ennsylvania Rule of Civil Procedure 205.5. (Cover Sheet) provides, in part: 

 
Rule 205.5.  Cover Sheet  

(a)(1)  This rule shall apply to all actions governed by the rules of civil procedure except 

the following: 

 

 

  P

 
 

 

1915.1 et seq. 

1930.1 et seq. 

 

 

 

 

completed cover sheet. 

provisions of this rule.   

(vi) 

voluntary mediation in custody actions, Rules 1940.1 et seq. 

(2) 

At  the  commencement  of  any  action,  the  party  initiating  the  action  shall  complete 

the cover sheet set forth in subdivision (e) and file it with the prothonotary. 

(b) 

The prothonotary shall not accept a filing commencing an action without a            

(c) 

The prothonotary shall assist a party appearing pro se in the completion of the form. 

(d) 

A  judicial  district  which  has  implemented  an  electronic  filing  system  pursuant  to 

Rule 205.4 and has promulgated those procedures pursuant to Rule 239.9 shall be exempt from the 

(e) 

The Court Administrator of Pennsylvania, in conjunction with the Civil Procedural 

Rules Committee, shall design and publish the cover sheet.  The latest version of the form shall be 

published on the website of the Administrative Office of Pennsylvania Courts at www.pacourts.us.

Cover Sheet template_Final

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Pennsylvania state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.pacourts.us (2023-03)
Page(s): 2
Fields(s): 85
Average fields per page: 42
Reading Level: Grade 13
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02