Designation Form (With Instructions) printable pdf download

Designation Form (With Instructions)

UNITED STATES DISTRICT COURT

Plaintiff-Appell__________,

District Court No. ___________________

Court of Appeals No.

Defendant-Appell________.

___________________

(if known)

NOTE: THIS DESIGNATION FORM MUST BE COMPLETED AND FILED IN

ACCORDANCE WITH THE INSTRUCTIONS ON THE REVERSE SIDE OF THE

FORM.

Those original papers which have been designated by circling their respective docket

numbers (or dates of entry) on the attached copy of the district court’s docket sheets should be

included in the record on appeal prepared by the clerk of the district court and transmitted to

the clerk of the court of appeals. (If the district court clerk so elects, original papers may be

retained in the district court and copies thereof may be included in the record on appeal.)

The following items should also be included in the record on appeal. (Portions of

transcripts should be designated by hearing dates and page numbers.)

1.____________________________________________________________________

2.____________________________________________________________________

3.____________________________________________________________________

4.____________________________________________________________________

5.____________________________________________________________________

(Attach additional sheets if necessary)

Signature: _______________________________

Counsel for: ________________________________

I hereby certify that a copy of this designation, with docket sheets attached, was mailed on

opposing counsel and the clerk of the court of appeals on _____________________________.

Signature: ______________________________________

Designation Form (With Instructions)