Form Ii - Civil Docket Statement
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1First District
Form II
Court of Appeals
Rev. 5/01
Civil Docket Statement
(Must Be Typed and 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(A) Civil Rule 54-B
If yes, does the judgment include a certification of
If multiple judgments or claims:
"No Just Cause for Delay?"
Yes
No
Does Civil Rule 54-B Apply:
Yes No
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 are 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.
BE SURE TO NOTE IF THIS APPEAL IS PURSUANT TO APP R. 11.2 ADOPTION OR TERMINATION OF PARENTAL RIGHTS.
(
) APP R. 11.2 ADOPTION OR
(
) Insurance
Trial Matters
(
) Landlord/Tenant
(
)
Evidence
TERMINATION OF PARENTAL RIGHTS
(
) Procedure/Rules
(
)
Jury Instructions
(
) Administrative
___
_________
(
) Real Property
(
)
Expert Witnesses
(
) Attorney Fees
(
) Summary Judgment
(
)
Other:
(
) Civil Service
(
) Tax
(
) Weight of Evidence
(
) Constitutional Law
Tort
(
) Other:
(
) Contracts
(
)
Intentional Tort - Workplace
(
) Corporations/Partnerships
(
)
Malpractice
(
) Unemployment Compensation
(
) Damages
(
)
Negligence - Auto
(
) Weight/Sufficiency of Evidence
(
) Declaratory Judgment
(
)
Negligence -
(
) Workers Compensation
Domestic Relations/Children
(
)
Product Liability
(
) Writs
(
)
Child Support
(
)
Slip and Fall
(
) Zoning
(
)
Custody
(
)
Other:
(
) Other:
(
)
Dependency
(
)
Divorce
(
)
Other:__________________
15. Probable Issues for Review
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:
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