This form contains 137 fields organized into 16 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Attorney Information
(c) Attorneys (Firm Name, Address, and Telephone Number) Text
Enter the firm name, address, and telephone number of the plaintiff's attorneys.
Attorneys (If Known) Text
Enter the names, firm name, address, and telephone number of the defendant's attorneys, if known.
Basis of Jurisdiction
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate option for the basis of jurisdiction.
q5 RadioButton
Select the appropriate basis of jurisdiction for the case. This is one of the radio buttons to indicate the jurisdiction basis.
q5 RadioButton
Select the appropriate basis of jurisdiction for the case. This is one of the radio buttons to indicate the jurisdiction basis.
q5 RadioButton
Select the appropriate basis of jurisdiction for the case. This is one of the radio buttons to indicate the jurisdiction basis.
q5 RadioButton
Select the appropriate basis of jurisdiction for the case. This is one of the radio buttons to indicate the jurisdiction basis.
q5 RadioButton
Select the appropriate basis of jurisdiction for the case. This is one of the radio buttons to indicate the jurisdiction basis.
Case Details
Class Action CheckBox
Check this box if the case is a class action lawsuit.
jury RadioButton
Select this radio button if a jury trial is requested.
jury RadioButton
Select this radio button if a jury trial is not requested.
Case Information
JUDGE Text
Enter the name of the judge assigned to the case.
MAG. JUDGE Text
Enter the name of the magistrate judge assigned to the case.
Cause of Action
Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity Text
Cite the U.S. Civil Statute under which you are filing. Do not cite jurisdictional statutes unless diversity.
Brief description of cause Text
Provide a brief description of the cause of action.
Citizenship of Principal Parties
PTF 1 CheckBox
Check this box if the plaintiff is a citizen of this state.
PTF 2 CheckBox
Check this box if the plaintiff is a citizen of another state.
PTF 3 CheckBox
Check this box if the plaintiff is a citizen or subject of a foreign country.
PTF 4 CheckBox
Check this box if the plaintiff is a corporation incorporated in this state.
PTF 5 CheckBox
Check this box if the plaintiff is a corporation incorporated in another state.
PTF 6 CheckBox
Check this box if the plaintiff is a foreign nation.
DEF 1 CheckBox
Check this box if the defendant is a citizen of this state.
DEF 2 CheckBox
Check this box if the defendant is a citizen of another state.
q5 RadioButton
Select the appropriate option for the citizenship of principal parties.
q5 RadioButton
Select the appropriate option for the citizenship of principal parties.
Complaint Details
DEMAND Text
Enter the demand amount in the complaint.
Defendant Information
County of Residence of First Listed Defendant Text
Enter the county of residence for the first listed defendant.
Defendants Text
Enter the names of the defendants involved in the case.
Defendants
DEF 3 CheckBox
Check this box if there is a third defendant involved in the case.
DEF 4 CheckBox
Check this box if there is a fourth defendant involved in the case.
DEF 5 CheckBox
Check this box if there is a fifth defendant involved in the case.
DEF 6 CheckBox
Check this box if there is a sixth defendant involved in the case.
Filing Information
RECEIPT Text
Enter the receipt number for the filing fee.
AMOUNT Text
Enter the amount of the filing fee.
APPLYING IFP Text
Indicate if you are applying for In Forma Pauperis (IFP) status.
Form Completion
DATE Text
Enter the date when the form is being filled out.
SIGNATURE OF ATTORNEY OF RECORD Text
Enter the signature of the attorney of record.
Jurisdiction
q2 RadioButton
Select the appropriate option for the basis of jurisdiction.
q2 RadioButton
Select the appropriate option for the basis of jurisdiction.
q2 RadioButton
Select the appropriate option for the basis of jurisdiction.
q2 RadioButton
Select the appropriate option for the basis of jurisdiction.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
q4 RadioButton
Select the appropriate jurisdiction basis for the case. Options may include Federal Question, U.S. Government Plaintiff, U.S. Government Defendant, Diversity, etc.
Nature of Suit
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
q4 RadioButton
Select the appropriate option for the nature of the suit.
Plaintiff Information
(b) County of Residence of First Listed Plaintiff Text
Enter the county of residence for the first listed plaintiff.
I. (a) PLAINTIFFS Text
Enter the names of the plaintiffs involved in the case.
Question 4
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
q4 RadioButton
Select this option if it corresponds to the specific question 4 criteria.
Related Cases
Judge Text
Enter the name of the judge for related cases.
DOCKET NUMBER Text
Enter the docket number for related cases.