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Attorneys/parties must submit the information contained in this form upon the resolution (whether by dismissal, settlement, final judgment, etc.) of most civil cases in Alaska state courts. See AS 09.68.130; Civil Rule 41(a)(3); Appellate Rule 511(e). Complete all the information on this page. The only excluded civil case types are: 

The information collected in this form is confidential and will be used only to compile statistics and summaries in a manner that does not allow the identification of particular cases or parties. AS 09.68.130(b). Each party, including pro se parties, must complete this form. Attorneys submitting this form for more than one party should  fill out a separate form for each party.

  v.  

 

Case Type (check all applicable)

Relief Sought
(check all applicable)

Medical Malpractice   

 Property Damage - Auto   Compensatory: Actual

Legal Malpractice  

 Property Damage - Other Compensatory: Non-Economic
Other Malpractice  

Employment      

Punitive
Personal Injury - Auto Debt   Costs/Attorney Fees
Personal Injury - Premises Other Business Dispute    Injunctive Relief
Personal Injury - Product Real Estate
Personal Injury - Other Other Civil

For all fields on this form which contain a zero, either

1) leave the zero in the field or
2) replace the zero with numbers only (no $, decimal, comma)

If the zero is deleted or replaced with anything but
numbers, an error will occur when you press the submit
button and the information will not be submitted.
You can press the "Back" button to return to this screen
and re-enter information.
Date Filed:       
Date Disposed:



Total Judgment/Settlement:


% of Judgment Covered
by Liability Insurance:


Disposition
(pick one):

    


Disposition After?
(check all applicable)
Bench Trial
Jury Trial
Appeal Filed     Appeal #


Non-Economic Award:  
Punitive Award:            

Declaratory Relief Award?  
                              Yes           No
Party First Name:
Party Last Name:
Party Type:
Other:         
(If party name is only one name, 
enter it in last name field.)

 

The Party's Own Fees and Costs

Fee Type Percent of Judgment if contingent; hourly rate if hourly1 Total
(of the party's own) 		Gross Judgment/Settlement (for or against this party) including Attorney Fees and Costs
  Contingent
  Hourly
  Flat Fee
  State/Local
  In-house
  Pro Se
  Other

%
of Judgment

OR

$ /hr.
if hourly

 Attorney Fees
$

Costs
$

 $

 

Attorney Fees/Costs for (payable to) this Party
by Another Party; or Against this Party
to Another Party

 
Attorney Fees Awards Costs Awards Total money to Client after all Fees/Costs Deducted (if any)2

Not separable?3   

For $

Against $


Not separable?3   

For $

Against $

$
Did you use Alternative Dispute Resolution?




Mediation
Arbitration
Early Neutral Evaluation
Settlement Conference

Did your case settle as a result of ADR?   
                                         Yes      No


Notes:


Other Parties

Their Attorney
(type 'no attorney' if pro se)



Name of attorney submitting form
(or party if no attorney)



Telephone Number



e-mail address


 

      1 Round all money amounts to the nearest dollar.

       2 "Costs" as used on this form is limited to litigation costs (excluding attorney fees) and does not include such things as medical expenses.

       3 If attorney fees/costs are not separable from the gross judgment (usually the case for settlements), check this box and go to the next item.