Supreme Court Of Louisiana Writ Application Filing Sheet
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1SUPREME COURT OF LOUISIANA
WRIT APPLICATION FILING SHEET
NO.___________________________________
TO BE COMPLETED BY COUNSEL or PRO SE LITIGANT FILING APPLICATION
TITLE
Applicant:_______________________________________
Have there been any other filings in this
______________________________________
Court in this matter?
Yes
No
VS.
Are you seeking a Stay Order?_____
Priority Treatment?_____
______________________________________
If so you MUST complete & attach a Priority
Form
LEAD COUNSEL/PRO SE LITIGANT INFORMATION
APPLICANT:
RESPONDENT:
Name:_________________________________________ Name:__________________________________________
Address:_______________________________________ Address:________________________________________
________________________________________
________________________________________
PhoneNo._______________ Bar Roll No.____________
PhoneNo._______________ Bar Roll No.____________
Pleading being filed:
In proper person,
In Forma Pauperis
Attach a list of additional counsel/pro se litigants, their addresses, phone numbers and the parties they represent.
TYPE OF PLEADING
Civil,
Criminal,
R.S. 46:1844 protection,
Bar,
Civil Juvenile,
Criminal Juvenile,
Other
CINC,
Termination,
Surrender,
Adoption,
Child Custody
ADMINISTRATIVE OR MUNICIPAL COURT INFORMATION
Tribunal/Court:_________________________________________ Docket No.________________________________
Judge/Commissioner/Hearing Officer:________________________________ Ruling Date:_____________________
DISTRICT COURT INFORMATION
Parish and Judicial District Court:____________________________________Docket Number:__________________
Judge and Section:______________________________________Date of Ruling/Judgment:_____________________
APPELLATE COURT INFORMATION
Circuit:__________ Docket No.__________________ Action:____________________________________________
Applicant in Appellate Court:_______________________________________________ Filing Date:________________
Ruling Date:____________ Panel of Judges:________________________________________________ En Banc:
REHEARING INFORMATION
Applicant:_________________________________ Date Filed:___________ Action on Rehearing:_______________
Ruling Date:____________ Panel of Judges:________________________________________________ En Banc:
PRESENT STATUS
Pre-Trial, Hearing/Trial Scheduled date:_____________________________,
Trial in Progress,
Post Trial
Is there a stay now in effect?______ Has this pleading been filed simultaneously in any other court?______
If so, explain briefly_________________________________________________________________________________
_______________________________________________________________________________________________.
VERIFICATION
I certify that the above information and all of the information contained in this application is true and correct to
the best of my knowledge and that all relevant pleadings and rulings, as required by Supreme Court Rule X, are
attached to this filing. I further certify that a copy of this application has been mailed or delivered to the
appropriate court of appeal (if required), to the respondent judge in the case of a remedial writ, and to all other
counsel and unrepresented parties.
DATE
SIGNATURE
C:\Documents and Settings\clemann\Local Settings\Temp\Filing Sheet.wpd
Revised 10-11-2002
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