Civil Appeals Statement Form - United States Court Of Appeals
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2File Stamp
UNITED STATES COURT OF APPEALS
Rev. 2/11
FOR THE ELEVENTH CIRCUIT
CIVIL APPEAL STATEMENT
11th Circuit Docket Number: _________________________________
Please TYPE. Attach additional pages if necessary.
Caption:
District and Division:
Name of Judge:
Nature of Suit:
Date Complaint Filed:
District Court Docket Number:
Date Notice of Appeal Filed:
9 Cross Appeal 9 Class Action
Has this matter previously been before this court?
9 Yes 9 No
If Yes, provide
(a) Caption:
(b) Citation:
(c) Docket Number:
Telephone, Fax, and Email
Attorney Name Mailing Address
For Appellant:
9 Plaintiff
9 Defendant
9 Other (Specify)
For Appellee:
9 Plaintiff
9 Defendant
9 Other (Specify)
Please CIRCLE/CHECK/COMPLETE the items below and on page 2 that apply.
Jurisdiction Nature of Judgment Type of Order Relief
Federal Question
Final Judgment,
Dismissal/Jurisdiction
Amount Sought by Plaintiff:
28 USC 1291
$_______________________
Diversity
Default Judgment
Interlocutory Order,
Amount Sought by Defendant:
US Plaintiff
28 USC 1292(a)(1)
Summary Judgment
$_______________________
US Defendant
Interlocutory Order Certified,
Judgment/Bench Trial
Awarded:
28 USC 1292(b)
$_______________________
Judgment/Jury Verdict
to ______________________
Interlocutory Order,
Qualified Immunity
Judgment/Directed Verdict/NOV
Injunctions:
9 TRO
9 Preliminary
9 Granted
Injunction
Final Agency Action (Review)
9 Permanent 9 Denied
54(b)
Other ________________________
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