Form UCS-840A, Request for Judicial Intervention Addendum Instructions
This form contains 127 fields organized into 1 section. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| For use when additional space is needed to provide party or related case information | ComboBox |
Select the court type to indicate whether this extra information pertains to a County or Supreme court situation, used when additional space is needed for party or related case details.
County
Supreme
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| _COURT, COUNTY OF | ComboBox |
Choose the county number from the dropdown list for the court that is handling the case.
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| Index No | Text |
Enter the Index Number for the case, which identifies the judicial intervention case in the court system.
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| Unrepresented_1 | CheckBox |
Mark this box if party #1 is unrepresented by an attorney, indicating the party does not have legal representation.
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| Party_Last_Name_1 | Text |
Provide the last name of party #1 involved in the case.
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| Party_First_Name_1 | Text |
Provide the first name of party #1 involved in the case.
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| Party_Primary_Role_1 | ComboBox |
Select the primary role of party #1 in this case from the available options.
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1
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| Party_Secondary_Role_1 | ComboBox |
Select the secondary role of party #1 in this case if applicable.
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7
1
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| Attorney_Last_Name_1 | Text |
Enter the last name of the attorney representing party #1, if party #1 is represented.
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| Attorney_First_Name_1 | Text |
Enter the first name of the attorney representing party #1, if party #1 is represented.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Role(s):) | Text |
Provide comprehensive contact information for all attorneys who have appeared in the case, including their name, firm name, business address, phone number, e-mail, and the role(s) they play.
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| Attorney_Street_Address_1 | Text |
Enter the first line of the attorney's street address.
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| Attorney_City_1 | Text |
Enter the attorney's city.
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| Attorney_State_1 | ComboBox |
Select the attorney's state from the list.
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26
2
38
43
48
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30
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24
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8
15
7
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13
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46
50
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20
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5
39
12
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35
42
49
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14
34
10
31
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40
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| Attorney_ZipCode_1 | Text |
Enter the attorney's ZIP code.
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| Attorney_Phone_1 | Text |
Enter the attorney's phone number (up to 10 digits).
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| Attorney_Fax_1 | Text |
Enter the attorney's fax number (up to 10 digits).
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| Attorney_email_1 | Text |
Enter the attorney's email address.
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| topmostSubform[0].Page1[0].Issue_Joined_1[0]_1 | RadioButton |
Select this option if the case issue is joined under the first option.
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| topmostSubform[0].Page1[0].Issue_Joined_1[0]_2 | RadioButton |
Select this option if the case issue is joined under the second option.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the name of the insurance carrier(s) or indicate the associated status (e.g., YES/NO) if applicable.
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| Unrepresented_2 | CheckBox |
Check if the litigant is unrepresented by an attorney.
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| Party_Last_Name_2 | Text |
Enter the last name of the party involved.
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| Party_First_Name_2 | Text |
Enter the first name of the party involved.
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| Party_Primary_Role_2 | ComboBox |
Select the primary role for party 2 from the available choices.
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4
2
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7
1
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| Party_Secondary_Role_2 | ComboBox |
Select the secondary role for party 2 from the available choices.
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4
2
3
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6
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7
1
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| Attorney_Last_Name_2 | Text |
Enter the attorney's last name for party 2.
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| Attorney_First_Name_2 | Text |
Enter the attorney's first name for party 2.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Name: Role(s):) | Text |
Provide comprehensive details for all attorneys that have appeared in the case. Include name, firm name, business address, phone number, e-mail, and role(s).
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| Attorney_Street_Address_2 | Text |
Enter the attorney's street address for party 2.
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| Attorney_City_2 | Text |
Enter the city for the attorney's address for party 2.
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| Attorney_State_2 | ComboBox |
Select the state for the attorney's address for party 2 from the available options.
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27
26
2
38
43
48
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16
29
30
32
18
24
3
8
15
7
22
13
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46
50
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20
44
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5
39
12
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35
42
49
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14
34
10
31
1
40
11
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| Attorney_ZipCode_2 | Text |
Enter the zip code for the attorney's address for party 2.
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| Attorney_Phone_2 | Text |
Enter the attorney's phone number for party 2, using up to 10 digits.
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| Attorney_Fax_2 | Text |
Enter the attorney's fax number for party 2, using up to 10 digits.
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| Attorney_email_2 | Text |
Enter the attorney's e-mail address for party 2.
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| topmostSubform[0].Page1[0].Issue_Joined_2[0]_1 | RadioButton |
Select this option to indicate that issues in the case are joined.
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| topmostSubform[0].Page1[0].Issue_Joined_2[0]_2 | RadioButton |
Select this alternative option if the issues in the case are not joined.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the name(s) of the insurance carrier(s) related to the case. Follow the prompt instructions regarding YES or NO if applicable.
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| Unrepresented_3 | CheckBox |
Check this box if the party is unrepresented (i.e., does not have legal counsel).
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| Party_Last_Name_3 | Text |
Enter the last name of the party involved in the case.
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| Party_First_Name_3 | Text |
Enter the first name of the party involved in the case.
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| Party_Primary_Role_3 | ComboBox |
Select the primary role of the party from the provided options (represented by numbers) that best describes their function in the case.
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| Party_Secondary_Role_3 | ComboBox |
Select the secondary role of the party, if applicable, from the available options.
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2
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7
1
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| Attorney_Last_Name_3 | Text |
Enter the last name of the attorney representing a party in the case.
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| Attorney_First_Name_3 | Text |
Enter the first name of the attorney representing a party in the case.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Name: Role(s):) | Text |
Provide comprehensive contact information for all attorneys who have appeared in the case. Include their name, firm name, business address, phone number, email, and role(s).
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| Attorney_Street_Address_3 | Text |
Enter the street address of the attorney's office or business.
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| Attorney_City_3 | Text |
Enter the city for the attorney's office or business address.
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| Attorney_State_3 | ComboBox |
Select the state for Attorney 3 from the dropdown list. This identifies the jurisdiction where the attorney is licensed.
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27
26
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48
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13
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20
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5
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| Attorney_ZipCode_3 | Text |
Enter the ZIP code for Attorney 3's office address.
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| Attorney_Phone_3 | Text |
Input Attorney 3's phone number. The field accepts up to 10 digits for proper contact information.
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| Attorney_Fax_3 | Text |
Input Attorney 3's fax number. The field is limited to 10 digits.
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| Attorney_email_3 | Text |
Provide the email address for Attorney 3 for electronic communications.
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| topmostSubform[0].Page1[0].Issue_Joined_3[0]_1 | RadioButton |
Select the first option for the 'Issue Joined' question related to Attorney 3. Choose the appropriate selection based on whether the issue is joined.
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| topmostSubform[0].Page1[0].Issue_Joined_3[0]_2 | RadioButton |
Select the second option for the 'Issue Joined' question related to Attorney 3. Use this field to indicate your answer if not selecting the first option.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the details regarding Insurance Carrier(s). Include information such as whether an insurance carrier is involved by indicating 'G YES' or 'G NO' as applicable.
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| Unrepresented_4 | CheckBox |
Check this box if Party 4 is unrepresented by an attorney, indicating self-representation in the case.
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| Party_Last_Name_4 | Text |
Enter the last name of Party 4 involved in the case.
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| Party_First_Name_4 | Text |
Enter the first name of Party 4 involved in the case.
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| Party_Primary_Role_4 | ComboBox |
Select the primary role of Party 4 from the available options. This categorizes their involvement in the judicial intervention.
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| Party_Secondary_Role_4 | ComboBox |
Select the secondary role of the party involved in the case from the provided list of role codes.
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7
1
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| Attorney_Last_Name_4 | Text |
Enter the last name of the attorney representing the party. This field is required if the party is represented by counsel.
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| Attorney_First_Name_4 | Text |
Enter the first name of the attorney representing the party.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Name: Role(s):) | Text |
Provide the complete contact details for all attorneys that have appeared in the case. Include name, firm name, business address, phone number, e-mail, and the respective roles.
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| Attorney_Street_Address_4 | Text |
Enter the street address of the attorney.
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| Attorney_City_4 | Text |
Enter the city for the attorney's business address.
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| Attorney_State_4 | ComboBox |
Select the state for the attorney's business address from the provided list of state codes.
21
27
26
2
38
43
48
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16
29
30
32
18
24
3
8
15
7
22
13
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46
50
25
20
44
9
5
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12
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35
42
49
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14
34
10
31
1
40
11
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17
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37
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| Attorney_ZipCode_4 | Text |
Enter the ZIP code corresponding to the attorney's business address.
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| Attorney_Phone_4 | Text |
Enter the attorney's phone number. This field expects a numeric value with a maximum length of 10 digits.
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| Attorney_Fax_4 | Text |
Enter the attorney's fax number. This text field is restricted to a maximum of 10 digits.
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| Attorney_email_4 | Text |
Enter the email address of the attorney.
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| topmostSubform[0].Page1[0].Issue_Joined_4[0]_1 | RadioButton |
Indicate if there is a joined issue in the case. This radio button field allows selection related to joined issues or related case actions.
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| topmostSubform[0].Page1[0].Issue_Joined_4[0]_2 | RadioButton |
Select whether the joined issue applies to this case. The radio button indicates if an additional issue is being joined.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the name or details of the insurance carrier. Use this field if insurance information is applicable.
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| Unrepresented_5 | CheckBox |
Tick this checkbox if the party involved is not represented by an attorney.
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| Party_Last_Name_5 | Text |
Enter the party's last name involved in the case.
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| Party_First_Name_5 | Text |
Enter the party's first name involved in the case.
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| Party_Primary_Role_5 | ComboBox |
Choose the party's primary role from the provided options.
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7
1
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| Party_Secondary_Role_5 | ComboBox |
Choose the party's secondary role from the provided options if applicable.
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4
2
3
5
6
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7
1
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| Attorney_Last_Name_5 | Text |
Enter the last name of the attorney representing the party.
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| Attorney_First_Name_5 | Text |
Enter the first name of the attorney representing the party.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Name: Role(s):) | Text |
Provide the complete contact details for all attorneys who have appeared in the case. Include name, firm name, business address, phone number, email, and role(s).
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| Attorney_Street_Address_5 | Text |
Enter the street address of the attorney handling the case.
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| Attorney_City_5 | Text |
Enter the city portion of the attorney’s contact address.
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| Attorney_State_5 | ComboBox |
Select the state in which the attorney is licensed or operates. The dropdown choices are state codes.
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27
26
2
38
43
48
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30
32
18
24
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8
15
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13
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46
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25
20
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5
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10
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| Attorney_ZipCode_5 | Text |
Enter the ZIP code for the attorney's office location.
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| Attorney_Phone_5 | Text |
Enter the attorney's 10-digit phone number for contact purposes.
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| Attorney_Fax_5 | Text |
Enter the attorney's 10-digit fax number.
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| Attorney_email_5 | Text |
Enter the email address of the attorney.
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| topmostSubform[0].Page1[0].Issue_Joined_5[0]_1 | RadioButton |
Select the first option for the issue joining indicator related to the case details.
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| topmostSubform[0].Page1[0].Issue_Joined_5[0]_2 | RadioButton |
Select the second option for the issue joining indicator related to the case details.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the insurance carrier information. Indicate YES or NO if applicable.
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| Unrepresented_6 | CheckBox |
Check this box if the party is not represented by an attorney.
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| Party_Last_Name_6 | Text |
Enter the last name of the party involved in the case.
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| Party_First_Name_6 | Text |
Enter the first name of the party involved in the case.
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| Party_Primary_Role_6 | ComboBox |
Select the primary role of the party in the judicial case from the given options.
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| Party_Secondary_Role_6 | ComboBox |
Select the secondary role for party number 6 involved in the case. The dropdown value identifies the party’s specific function or position.
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| Attorney_Last_Name_6 | Text |
Enter the last name of the attorney representing party number 6.
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| Attorney_First_Name_6 | Text |
Enter the first name of the attorney representing party number 6.
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| (address of all attorneys that have appeared in the case. Provide name, firm name, business address, phone number and e-mail, Name: Role(s):) | Text |
Provide comprehensive contact details for all attorneys who have appeared in the case. This should include each attorney’s name, firm name, business address, phone number, email, and their role(s) in the case.
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| Attorney_Street_Address_6 | Text |
Enter the street address for attorney number 6.
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| Attorney_City_6 | Text |
Enter the city where attorney number 6’s office is located.
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| State | ComboBox |
Select the state for attorney number 6 from the dropdown list provided.
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27
26
2
38
43
48
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16
29
30
32
18
24
3
8
15
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22
13
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46
50
25
20
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5
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| Attorney_ZipCode_6 | Text |
Enter the ZIP code for attorney number 6’s office address.
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| Attorney_Phone_6 | Text |
Enter the 10-digit phone number for attorney number 6. Only numeric digits should be entered.
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| Attorney_Fax_6 | Text |
Enter the 10-digit fax number for attorney number 6. Only numeric digits should be provided.
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| Fax | Text |
Enter the email address for attorney number 6. This field expects a valid email format.
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| topmostSubform[0].Page1[0].Issue_Joined_6[0]_1 | RadioButton |
Indicate whether the issue is joined with respect to party or attorney number 6 by selecting the appropriate radio button.
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| topmostSubform[0].Page1[0].Issue_Joined_6[0]_2 | RadioButton |
Select whether the specific issue is joined in this case using the provided radio button.
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| (Insurance Carrier(s):, G YES G NO) | Text |
Enter the insurance carrier information or indicate 'YES'/'NO' based on the presence of an insurance carrier.
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| (Case Title, <Row 1>) | Text |
Provide the title of the related case for Row 1.
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| (Index/Case No., <Row 1>) | Text |
Enter the index or case number for the related case in Row 1.
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| (Court, <Row 1>) | Text |
Type the name of the court where the related case (Row 1) was filed.
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| (Judge (if assigned), <Row 1>) | Text |
Enter the name of the judge (if assigned) for the related case in Row 1.
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| (Relationship to Instant Case, <Row 1>) | Text |
Describe the relationship of the related case in Row 1 to the current case.
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| (Case Title, <Row 2>) | Text |
Provide the title of the related case for Row 2.
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| (Index/Case No., <Row 2>) | Text |
Enter the index or case number for the related case in Row 2.
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| (Court, <Row 2>) | Text |
Type the name of the court where the related case (Row 2) was filed.
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| (Judge (if assigned), <Row 2>) | Text |
Enter the name of the judge (if assigned) for the related case in Row 2.
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| (Relationship to Instant Case, <Row 2>) | Text |
Describe the relationship of the related case in Row 2 to the current case.
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| (Case Title, <Row 3>) | Text |
Provide the title of the related case for Row 3.
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| (Index/Case No., <Row 3>) | Text |
Enter the index or case number for the related case in Row 3.
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| (Court, <Row 3>) | Text |
Type the name of the court where the related case (Row 3) was filed.
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| (Judge (if assigned), <Row 3>) | Text |
Enter the name of the judge assigned to the related case (if one has been designated) as indicated in Row 3.
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| (Relationship to Instant Case, <Row 3>) | Text |
Provide your relationship to the instant case (e.g., party, attorney, or other connection) as specified in Row 3.
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| Print Form | Button |
This button prints the form. Click it when you are ready to generate a printed copy of the completed form.
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