Lower Court Information - Louisiana Court Of Appeal

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APPENDIX E: LOUISIANA COURT OF APPEAL, SECOND CIRCUIT WRIT APPLICATION INTAKE FORM

TO BE COMPLETED BY PARTY FILING APPLICATION

Approved by Administrative Court Conference April 3, 2014

TYPE OF PLEADING: _____Civil

_____Criminal

_____Other (explain) _______________________________________

Expedited Consideration Requested?

_____Yes

_____No

Stay Order Requested?

_____Yes

_____No

If yes, on what basis? _________________________________________________________________________________________

Pleading being filed ______ By Attorney ______ In Proper Person/Pro Se _______ In Forma Pauperis (

)

pauper order must be attached

LOWER COURT INFORMATION

CASE TITLE: ______________________________________________________________________________________________

Versus

___________________________________________________________________________________________________________

Parish and Judicial District: ______________________________________________ Docket No(s):___________________________

Trial/Ruling Judge: ____________________________________________________ Ruling Date: ____________________________

What was the ruling of the trial court? _____________________________________________________________________________

PRESENT CASE STATUS

(please check all that apply)

_____Pretrial

_____Post-trial/hearing

_____Hearing or trial date and time: _____________________

_____Trial in progress

_____Bench trial

_____Jury trial

Stay by trial court?

______Denied

______Granted until_______________________

Lead counsel for Applicant

Lead counsel for Respondent

Name: ___________________________________________

Name: ____________________________________________

Firm Name: _______________________________________

Firm Name: ________________________________________

Address: __________________________________________

__________________________________________________

Phone No: ________________ Fax No: _________________

Email: ____________________________________________

Bar Roll No: ________ Name(s) of party/parties represented:

__________________________________________________

Attach a list of any additional counsel/pro se litigants, their addresses/contact information, and the parties they represent.

________Yes

________No

Have there been any previous filings, appeals or writ applications in this Court in this case

: _______________________________________________________________________________________________

If yes, explain

PENDING CASE INFORMATION

________Yes ________No

Are there any appeals or writ applications related to the present matter currently pending before this Court

: ___________________________________________

If yes, provide the appellate court docket number, date of filing and name of filing party

____________________________________________________________________________________________________________

_______Yes ______No

Would any of those pending matters impact the current filing or will the current filing impact any of the pending matters?

If yes, explain: _______________________________________________________________________________________________

____________________________________________________________________________________________________________

Has this pleading been filed simultaneously in any other court? _______Yes _______No

If yes, explain: _______________________________________________________________________________________________

VERIFICATION

I hereby verify 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, rulings, and orders, as required by Uniform Rules 4-2, 4-3 and 4-5 of the Courts of Appeal are attached to this filing. I further certify that a copy of this

application has been mailed or delivered to the respondent judge and to opposing counsel, and to any opposing party not represented by counsel. I understand that

failure to comply with Uniform Rules 4-2, 4-3 and 4-5 of the Courts of Appeal may result in the refusal to consider or dismissal of my application. Pursuant to URCA

Rule 4-5(D), I shall immediately notify the Court if any trial or hearing date is set or changes, or the need for expedited consideration changes due to settlement,

continuance, or any other circumstance. FAILURE TO NOTIFY THE COURT MAY SUBJECT ME TO PUNISHMENT FOR CONTEMPT OF COURT.

__________________________________________________________________________________________________

DATE

PRINT NAME

SIGNATURE/BAR ROLL NO.