Written Civil Case Filing Statement

CASE FILING STATEMENT - Informational Only; Not Retained in Case Records Provide the Case File No. for the record you are filing into or the Case Type if initiating a new action: _________________________ *Available Case Type options can be found on the UJS internet website at http://ujs.sd.gov/Information/Attorneys.aspx. Social Security Numbers (not Driver's License Numbers) must be provided for divorce, child support, & paternity cases, 42 USC 666(a)(13)(B). All filers are required to provide the SSN or DL# for each of their participants regardless of the case type. INFORMATION FOR PLAINTIFF/PETITIONER/APPLICANT: __________________________________ Last/Business Name __________________________________ Physical Address Check if Same as Physical __________________________________ Mailing Address __________________________________ First Name __________________________________ City _____________ Middle _____________ State ___________________________ Suffix ___________________________ Zip __________________________________ City _____________ State ___________________________ Zip Date of Birth: ______________________ mo/day/ yr ___________________________ Phone No. Attorney: ___________________________ Social Security No. ___________________ ____ Driver's License No. State _______________________________ Employer ID (if plf is a business) _________________________ Last Name ________________________ __________________ ________________________________ First Phone No. . State Bar ID # ___________________________ State ___________________________ Zip ___________________________ Mailing Address ___________________________ City INFORMATION FOR DEFENDANT/RESPONDENT: __________________________________ Last/Business Name __________________________________ Physical Address Check if Same as Physical __________________________________ Mailing Address __________________________________ First Name __________________________________ City _____________ Middle _____________ State ___________________________ Suffix ___________________________ Zip __________________________________ City _____________ State ___________________________ Zip Date of Birth: ______________________ mo/day/ yr ___________________________ Phone No. Attorney: ___________________________ Social Security No. ___________________ ____ Driver's License No. State _______________________________ Employer ID (if def is a business) _________________________ Last Name ________________________ __________________ ________________________________ First Phone No. . State Bar ID # ___________________________ State ___________________________ Zip ___________________________ Mailing Address ___________________________ City UJS-232 Rev. 11/29//2016 American LegalNet, Inc. www.FormsWorkFlow.com