Civil Template Library

Civil Template Library for Arkansas Attorneys

Obviously, you should never just take a template and use it without making sure it complies with the current state of the law and that it actually meets the need you have. But, templates can be a great place to start if you have a new issue that you’ve never dealt with before. I’m happy to offer this template library, with the caveat that templates are NOT legal advice, that you should not use these templates if you don’t know what you are doing, and that I make no guarantees that these are in compliance with current law. You’ll have to check that for yourself.

Help me build this library!

If you have a great template to add to this library, please feel free to send it in: hawglawblawg at gmail dot com.

 

GENERAL CIVIL

Official Form of Summons:  pdf here

Notice and acknowledgement for service by mail: pdf here

Instructions for Completing General Civil Cover Sheet: pdf here

Cover Sheet State of Arkansas Circuit Court: pdf here

Subpoena Form, Arkansas Rule of Civil Procedure 45 (Rev. 07/01/2010): pdf here

Motion for Extension of Time

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                               CASE NO. __________

DEFENDANT

MOTION FOR EXTENSION OF TIME

Comes now Plaintiff and for its Motion for Extension of Time states that:
1. Suit was filed on or about ________.
2. Plaintiff attempted to serve Defendant on _________ (date) by _____ (method).
3. The Plaintiff wishes to obtain service on said Defendant but the 120-day limit may
expire before service is accomplished, and Plaintiff needs additional time to serve. These facts
constitute good cause for an extension of time for service pursuant to Arkansas Rules of Civil
Procedure, Rule 4.
WHEREFORE, Plaintiff prays that the Court extend the time for service for an additional
120 days and for such other and further relief as the Court deems just and proper in the premises.

 

Discovery Documents

Notice to Take Deposition

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                             CASE NO. __________

DEFENDANT

Notice to Take Deposition

To:  Deponent (& address)

Please take notice that at 10:00am on ___________ at the law office of _____________, address, Defendant will take the depositon upon oral examination of the following person before a duly qualified court reporter:

NAME

Said deposition upon oral examination is taken pursuant to Rule 26 of the Arkansas Rules of Civil Procedure governing depositions. This deposition shall begin at the time specified and shall continue thereafter until completed.

DATE:

PLACE:

COURT REPORTER:

Dispositive Documents

Motion to Dismiss

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                             CASE NO. __________

DEFENDANT

Motion to Dismiss

Comes ______ and moves the court to dismiss the Complaint against it for the reasons set forth more fully in the brief in support of this motion.

General Settlement Agreement

Settlement and Release Agreement

Know all men by these presents:

That _______________ (name), for the sole consideration of ______Dollars ($____) to me (us) cash in hand paid, the receipt of which is hereby acknowledged, hereby release and discharge _____________ (as insurers of _______), and its (their) agents, servants and employees, of and from any and all claims, demands, damages, actions, causes of action, or suits at law or in equity, of whatsoever kind or nature, for or because of any matter or thing done, or omitted, or suffered to be done by the said parties herein released, prior to and including the date hereof, and particularly on account of the alleged ____________________________ (and date).

I (we) understand that by this Settlement and Release Agreement, ___________ (as insurer of ______________) and its (their) agents, servants and employees do no admit or acknowledge any fault or negligence on their part and that, on the contrary, they have continued to specifically deny the same.

As further consideration for the sum paid to me (us), I (we) hereby agree to indemnify, protect and hold harmless ________________ (as insurers of ______________ and their agents, servants and employees of and from all further claims, demands, costs, attorneys’ fees, expenses or judgments which might be incurred by or against them, or any of them, as a result of the alleged ______________ (and date).

I (we) understand that no representation as to the liability and no agreement or promise has been made by ______________, ( as insurer of ______________) and its (their) agents, servants and employees, or anyone on their behalf, to induce this Settlement and Release Agreement, and that the sum paid to me (us) is solely by way of compromise of a disputed claim. I (we) therefore specifically agree that this Settlement and Release Agreement contains the entire agreement between the parties with the terms hereof being contractual and not a mere recital.

I (we) further agree that in the even other parties are responsible to me (us), the execution of this Settlement and Release Agreement shall operate as a satisfaction of the claims against such other parties to the extent of the pro-rata share of the parties herein released.

I (we) further agree that the civil action no. ___________, now pending in the ______ Court, against ____________, shall be dismissed with prejudice.

I (we) have read this Settlement and Release Agreement, which consists of ___ pages, I we have initialed and dated each page, and I (we) have had it explained to me (us) by my (our) attorney, ________________, who has signed as a witness. I (we) fully understand that the sum paid to me (us) is in full and final compromise of any and all claims and causes of action, which I (we) now or ever will have against ______________ (as insurer of ______________), and their agents, servants and employees, as a result of the alleged ___________.

I (we), ________ and my (our) attorney, ____________________, hereby acknowledge and agree, as a condition of the compromise between the parties referred to in tis Settlement and Release Agreement, not to disclose the provisions of this Settlement and Release Agreement and agree to keep the terms and the amount of the settlement absolutely confidential.

It is the specific intent of the parties to this Settlement and Release Agreement for this Release to discharge all persons and entities that ___________ [medical care providers] and their insurance companies (if any) who were involved in any way with rendering care and treatment to ____________, and their insurance companies.

In witness thereof, I (we) have hereunto set my (our) hand this ___ day of _____, YEAR, in three (3) duplicate, original copies of this instrument.

CAUTION: READ BEFORE SIGNING!

___________________________

WITNESSED AND APPROVED AS TO FORM AND CONTENT:

__________________ ATTORNEY FOR ___________.

 

Order of Dismissal Following Settlement

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                             CASE NO. __________

DEFENDANT

ORDER OF DISMISSAL

On this day this cause came to be heard and it appearing to the Court that the matter has been compromised and settled, the above-styled cause against Defendants ___________, _________ and _____________ is hereby dismissed with prejudice.

It is so ordered this ____ day of ________________, YEAR.

Consent Judgment

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                     CASE NO. __________

DEFENDANT

CONSENT JUDGMENT

Now on this day, this cause comes on to be heard upon the Complaint of Plaintiff, the Summons and service thereof, in the manner and time prescribed by law. Plaintiff appearing by its attorney, _______, and Defendant by its attorney ___________, have consented to Judgment by signature, thereby announcing to the Court that the Defendant was indebted to the Plaintiff in the sum of $_____, plus pre-judgment interest in the amount of $0.00, for a total balance of $_____, together with costs accrued to date in the amount of $_____, plus attorney fees in the amount of $_____ and consents for Judgment to be entered thereon.

The Court, therefore, finds that the Plaintiff is entitled to Judgment against the Defendant in the sum of $_____, plus pre-judgment interest in the amount of $_____, for a total balance of $_____ together with costs accrued to date in the amount of $_____, plus attorney fees in the amount o f$_____. That said Judgment is to be paid at the rate of $_____ per month until paid in full. The Court further finds that pursuant to Act 610 of 1991, the Defendant is to prepare a schedule, verified by affidavit, of all property, both real and personal, including moneys, bank accounts, rights, credits, and choses in action held by Defendant, or other for the Defendant, and specify the particular property which the Defendant claims as exempt under the provisions of the law. Said schedule to be filed with the Clerk of this Court within (45) days after the entry of this Judgment.

IT IS THEREFORE, CONSIDERED, ORDERED, AND ADJUDGED that the Plaintiff does have and recover Judgment of and from the Defendant, ______, in the amount of $______, plus pre-judgment interest in the amount of $_____, for a total balance of $_____, together with costs accrued to date in the amount of $_____ and attorney fees in the amount of $_____. That said Judgment is to be paid at the rate of $_____ per month until paid in full. Said Judgment to bear interest at the maximum lawful rate of _________% per annum. If the Defendant fails to meet the obligations outline din this Judgment, then the Defendant may incur charged related to the enforcement of this Judgment. Further the Plaintiff may contact third parties to enforce this judgment. That pursuant to the Act of purusant to Act 610 of 1991, the Defendant is to prepare a schedule, verified by affidavit, of all property, both real and personal, including moneys, bank accounts, rights, credits, and choses in action held by Defendant, or other for the Defendant, and specify the particular property which the Defendant claims as exempt under the provisions of the law. Said schedule to be filed with the Clerk of this Court within (45) days after the entry of this Judgment.

 Order Dismissing One Defendant

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                             CASE NO. __________

DEFENDANT

ORDER

On this ___ day of ___, ______, comes for the Court’s consideration the separate defendant _______’s motion to dismiss (with/without) prejudice, and after due consideration of the facts, the law and all pleadings of records, this court finds that hte plaintiff’s motion should be and is hereby granted.

WHEREFORE, defendant ____________ is dismissed from this action as a party defendant. The dismissal is (with/without) prejudice.

IT IS SO ORDERED.

Judgment-Statute of Limitations Bar

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                             CASE NO. __________

DEFENDANT

ORDER

Comes now the Court on this ____ day of _____, ______________, in accordance with the memorandum opinion filed in the above-styled case on today’s date, and hereby considers, orders and adjudges that plaintiff’s amended complaint against separate defendant ____________, is barred by the state of limitations and is therefore dismissed with prejudice.

IT IS SO ORDERED.

PERSONAL INJURY

Affidavit of Custodian of Medical Records

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                             CASE NO. __________

DEFENDANT

AFFIDAVIT OF CUSTODIAN OF MEDICAL RECORDS

STATE OF ARKANSAS

COUNTY OF _______

Comes _______________, Custodian of Medical Records, and for his/her Affidavit regarding the above-referenced claim, states as follows:

1. That I am the Custodian of Medical Records of __________________(facility) and that I have the authority to certify said records;

2. That the copies of the medical records of __________________(patient’s name) attached to this Affidavit are true and correct copies of all of the records described in the request;

3. That the records were prepared by the personnel of the hospital (or type of facility), or persons acting under the control of (the facility or Dr.), in the ordinary course of the hospital’s business at or near the time of the act, condition or event.

FURTHER AFFIANT SAYETH NOT.

__________________________________

CUSTODIAN OF RECORDS

NOTARY BLOCK HERE

REAL PROPERTY

LANDLORD TENANT

DEBTOR/CREDITOR

Default Judgment

Interrogatories

Write of Garnishment

Order to Garnishee

IN THE CIRCUIT COURT OF __ COUNTY, ARKANSAS

PLAINTIFF

V                                                 CASE NO. __________

DEFENDANT

GARNISHEE & ADDRESS

ORDER TO GARNISHEE

Plaintiff, by and through its attorneys, has shown the Court a Judgment entered ________ against Defendant for $_______ (plus post judgment interest if applicable), the Writ issued to the Garnishee and the allegations and interrogatories filed therein, the Answer of the Garnishee, and from these things and all other proof before the Court, the Court finds:

1. Garnishee was summoned by Writ of Garnishment to Answer under oath respecting any credits or other personal property in its possession or under its control belonging to the Defendant. The amount of the garnishment was $20,719.89, plus inerest at the rate of 5.500% per annum.

2. Garnishee has answered that Defendant is employed by Garnishee.

3. Plaintiff’s Judgment against said Defendant is now in full force and effect and remains unpaid.

It is therefore ORDERED that Garnishee ________, remit to Plaintiff __________, the sum equivalent to 25% of the Defendant’s net disposable earnings for the work period or the amount by which the net disposable earnings exceeds 30 times the minimum wage under section 6(a)(1) of the Fair Labor Standards Act of 1933 (29 USC 206(a)(1)), immediately upon satisfaction of any prior garnishment lawfully issued or as funds become available which are subject to immediate garnishment under applicable federal or state laws.

Such withholding must commence with all checks issued or payments made to Defendant on or after date of service of the Writ of Garnishment. This garnishment shall remain in effect and continue as to all earnings until the total amount due upon the judgment and cost is paid or satisfied, or until the employee is no longer employed by Garnishee.

GARNISHEE SHALL MAKE ALL PAYMENTS FOR WITHHOLDS PAYABLE TO _____________ AND MAIL OR DELIVER SAME TO _______.

In the even that Garnishee mails funds directly to the Court, the Clerk is hereby authorized to pay any such funds to Counsel for Plaintiff at the address shown above.

IT IS SO ORDERED.

PROBATE-ESTATE PLANNING

DOMESTIC RELATIONS

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