First District
Form II
Court of Appeals
Rev. 3/95
Criminal Docket Statement
(Must Be Filed In Duplicate and Served On Opposing Counsel)
2. Appeal No. ______________________
1. Case Caption
3. Trial No. ________________________
4. Trial Judge ______________________
vs. _________________________________
_____________________________________
5. Related Appeals _________________
6. Date of Judgment/
Order Appealed From ______________
7. Date Appeal Filed ________________
8. Counsel for Appellant
9. Counsel for Appellee
E-Mail address
E-Mail address
10(B) Criminal Status
Counsel will make a reasonable effort to contact the client prior to merit hearing so that counsel
Counsel was appointed for trial
Yes No
can advise the court of the client’s status and desire to proceed with the appeal.
Counsel was appointed for appeal
Yes
No
Stay was granted by trial court
Yes No
Yes
No
Length of Sentence
If answered no, please explain: __________________________________________________
11. Record
There will be a partial transcript of proceedings filed.
Yes
No
The parts to be ordered are:
There will be a complete transcript of proceedings filed.
Yes
No
If either of the above is applicable the court reporter's certification below must be completed.
If neither of the above are applicable then one of the following must be circled:
There will be a statement filed pursuant to App. R. 9(C)
Yes
No
There will be an agreed statement filed pursuant to App. R. 9(D)
Yes
No
There is no transcript, statement or agreed statement to be filed.
Yes
No
Circling any of the above three will be deemed sufficient compliance with App. R. 9(C) and Local Rule 5.
12. Court Reporter's Certification
The transcript as ordered consists of approximately ___
pages and pursuant to Local Rule 10, the transcript will be
prepared and ready for filing on ___________________________
Date: ___________________________
Signature: _______________________________________________
13. Brief
Upon the filing of the complete record I request __________ days to file the brief and assignments of error.
14. Nature of Appeal
Please Check All That Apply and Provide Specific Information Whenever Space Is Provided.
(
)
DUI
(
) Arson
(
)
Sex Offense
(
)
Kidnapping
(
) Assault
(
)
Theft Offense
(
)
Murder
(
) Attempt
(
)
Traffic Offense
(
)
Death Penalty
(
) Automobile Offense
(
)
Weapons Offense
(
)
Post Conviction
(
) Burglary
(
)
Other
(
)
Probation
(
) Complicity, Conspiracy
(
)
Robbery
(
) Drug Offense
15. Probable Issues for Review
(
) Counsel was Recently Appointed and is Not Yet Able to Identify Probable Issue(s) For Review.
-OR-
Please Check All That Apply and Provide Specific Information Whenever Space Is Provided.
(
) Allied Offenses
(
) Prosecutor Search and
Trial Matters
(
) Constitutional Law
Seizure
(
) Evidence
(
) Counsel – Effective Assistance
(
) Arrest
(
) Expert Witnesses
(
) Crim. R. 11
(
) Miranda
(
) Jury Instructions
(
) Expungement
(
) Warrant
Witnesses
(
) ID/Photos
Other
:
(
) Other:
(
) Indictment/Complaint
(
) Sentencing
(
) Weight of Evidence
(
) Lesser Included Offenses
(
) Procedure/ Rules
(
) Probation
16. Case[s] and/or Statute[s] to be Discussed
17. Certificate of Service
I certify that I have mailed or otherwise delivered a copy of this docket statement to all counsel of record or the parties if unrepresented.
Date: _____________________________
Signature: ___________________________________________________