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This form shall be filed by the prevailing party for the use of the Clerk of Court for the purpose of reporting judicial workload data pursuant to Florida Statutes section 25.075. (See instructions on the reverse of the form.)

I. CASE STYLE

(Name of Court)                                           .

Plaintiff                                                                                              Case #                                               

                                                                                                            Judge                                                

vs.

Defendant                                        

II. MEANS OF FINAL DISPOSITION (Place an “x” in one box for major category and one subcategory, if applicable, only)

1. Dismissed Before Hearing

          a. Dismissed Pursuant to Settlement – Before Hearing

          b. Dismissed Pursuant to Mediated Settlement – Before Hearing

          c. Other – Before Hearing

2. Dismissed After Hearing

          a. Dismissed Pursuant to Settlement – After Hearing

          b. Dismissed Pursuant to Mediated Settlement – After Hearing

          c. Other After Hearing – After Hearing

3. Disposed by Default

4. Disposed by Judge

5. Disposed by Non-jury Trial

6. Disposed by Jury Trial

7. Other

DATE                                                                                                                                                

                                                SIGNATURE OF ATTORNEY FOR PREVAILING PARTY