IN THE COURT OF COMMON PLEAS OF WOOD COUNTY, OHIO

1 IN THE COURT OF COMMON PLEAS OF WOOD county , OHIO _____ Case No. _ _____ -vs-CASE DESIGNATION FORM _____ Has this case been previously filed and dismissed?_____ If yes, list Case No. and Judge:_____ List Pending or related cases:_____ **CATEGORIES** GENERAL CIVIL DOMESTIC RELATIONS _____PROFESSIONAL TORT ( medical/legal malpractice) _____PRODUCT LIABILITY (TORT) _____OTHER TORT ( auto accidents, personal Injuries, intentional act) WORKER S COMPENSATION _____State Funded _____Self-Insured _____FORECLOSURES ( real estate, Personal property) _____ADMINISTRATIVE APPEAL ( agency appeals) _____OTHER CIVIL ( promissory note defaults, fraud, contract disputes) _____VIOLATION OF ANTI-PREDATORY LENDING LAW _____CERT.

2 OF QUALIFICATION OF EMP. [MISC. CIVIL CQE)] I CERTIFY that to the best my knowledge the within case is not related to any now pending or previously filed case, except as noted above. _____ Signature Also, do you consider this case COMPLEX LITIGATION, pursuant to Sup. Rule 42 _____ (yes/no) DIVORCE COMPLAINT _____With Children _____Without Children DISSOLUTION _____With Children _____Without Children _____CHANGE OF CUSTODY _____VISITATION ENFC/MDFC _____SUPPORT ENFC/MDFC _____DOMESTIC VIOLENCE _____STALKING _____ALL OTHERS