COA-B (rev. 1/18) IN THE COURT OF APPEALS OF THE STATE OF ALASKA DOCKETING STATEMENT B FOR USE WITH PETITIONS FOR HEARING, PETITIONS FOR REVIEW, AND ORIGINAL APPLICATIONS 1. TYPE OF PETITION Type of Petition Superior Court Case Number Date of Distribution of Decision or Order to be Reviewed Superior Court Judge Subsequent Proceedings a. Petition for Hearing from Superior Court Petition for Rehearing: not filed filed. Date filed: Date of distribution of order denying petition: b. Petition for Review Motion for Reconsideration: not filed filed. Date filed: denied by order distributed: deemed denied under Civil Rule 77(k)(4). c. Original Application from trial court case No. . Judge . Other. Explain: . 2. PETITIONER a. Name c. Petitioner Mailing Address (not attorney222s address) b. Status in the Trial Court Plaintiff Defendant Other Specify: . City State Zip Code d. Telephone 3. PETITIONER222S ATTORNEYa. Name Court Apptd b. Bar Number c. Attorney Mailing Address d. Telephone e. Fax City State Zip Code f. Firm/Agency 4. RESPONDENT a. Name c. Respondent Mailing Address b. Status in the Trial Court Plaintiff Defendant Other Specify: . City State Zip Code d. Telephone (for court system use) No. INSTRUCTIONS FOR MULTIPLE PARTIES OR ATTORNEYS: If there are multiple parties or attorneys, repeat the appropriate box. This may be done on a separate page. Please clearly indicate which attorney represents which party. American LegalNet, Inc. www.FormsWorkFlow.com COA-B-2 (rev. 1/18) 5. RESPONDENT222S ATTORNEY a. Name Court Apptd b. Bar Number c. Attorney Mailing Address d. Telephone e. Fax City State Zip Code f. Firm/Agency 6. ATTACHMENTSThe following items are submitted with this form: a. The original petition and FIVE copies. b. A copy of the judgment or order from which relief is sought attached to the original petition and ALL copies. c. A $250 filing fee or a motion to appeal at public expense (financial statement affidavit form must be included). a motion to waive filing fee (financial statement affidavit form must be included). no filing fee is required because appellant is represented by court-appointed counsel. the state or an agency thereof. d. A motion for expedited action submitted not submitted. e. A motion for stay of trial court proceedings submitted not submitted. Date Signature of Petitioner or Petitioner222s Attorney CERTIFICATE OF SERVICE I certify that on a copy of this docketing statement and all attachments (except filing fee) were mailed delivered to All parties in the trial court (listed) Signature: American LegalNet, Inc. www.FormsWorkFlow.com