IN THE COURT OF APPEALS OF THE STATE OF ALASKA (for court system use) DOCKETING STATEMENT E FOR USE IN SENTENCE APPEALS UNDER APPELLATE RULE 215 Appeal filed by Defendant State of Alaska No. 1. DEFENDANT b. Did defendant have co-counsel status in the trial court? a. Name c. Defendant Mailing Address * (not attorney’s address) City State Zip Code YES NO YES NO UNKNOWN Will defendant seek co-counsel status in the appellate court? d. Telephone * If defendant is incarcerated, include name and mailing address of correctional facility. 2. DEFENDANT’S ATTORNEY IN APPEAL a. Name Court Apptd c. Attorney Mailing Address City Defendant not represented by attorney in appeal. b. Bar Number d. Telephone State Zip Code 3. DEFENDANT’S ATTORNEY IN TRIAL COURT e. Fax f. Firm/Agency Same as attorney in appeal. Defendant not represented by attorney in trial court. a. Name b. Bar Number c. Attorney Mailing Address d. Telephone City State Zip Code e. Fax f. Firm/Agency 4. PROSECUTING ATTORNEY * a. Name b. Bar Number c. Attorney Mailing Address d. Telephone City State Zip Code e. Fax f. Agency * Specify attorney who will handle appeal, if known. Otherwise, specify trial attorney. 5. TRIAL COURT PROCEEDING a. Case No. b. Trial Judge * c. Date Judgment Distributed * d. Post-Judgment Motions: List all post-judgment motions that affect time for filing appeal. See Appellate Rule 204(a)(4). DATE OF FILING Month Day Year DATE ORDER DISTRIBUTED Type of Post-Judgment Motion Month Day Year * Include probation revocation judge and date of distribution of probation revocation order, if applicable. COA-E (rev. 8/10) American LegalNet, Inc. www.FormsWorkFlow.com 5. TRIAL COURT PROCEEDING (continued) e. Co-Defendants: List all co-defendants in trial court proceeding. Co-Defendant’s Name Co-Defendant’s Trial Court Case No. f. Related Cases in the Trial Court: List all related trial court cases involving defendant (e.g., post-conviction relief proceeding under Criminal Rule 35.1, separate trial of defendant on related charges). DATE OF FILING Month Day Type of Proceeding Year Trial Court Case No. 6. SENTENCE BEING APPEALED Provide following information for each sentence being appealed: SENTENCE Count No. Offense Jail Other (specify) Fine PART OF SENTENCE BEING APPEALED Jail Other (specify) Fine 7. ATTACHMENTS The following items are submitted with this form: a. A copy of the final order or judgment from which the appeal is taken. b. A $150 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 of Alaska. I certify that I have reviewed Appellate Rule 215(a)(1) and that I believe this appeal is within the jurisdiction of the Court of Appeals as stated therein. Date Signature of Appellant or Appellant’s Attorney 8. ATTORNEY INFORMATION* a. Name b. Bar Number c. Attorney Mailing Address City State d. Telephone Zip Code e. Fax f. Firm/Agency *Complete this box only if the attorney who signs form is not the attorney named in box 2, 3, or 4. CERTIFICATE OF SERVICE I certify that on a copy of the notice of appeal, this docketing statement, and all attachments (except filing fee) were mailed delivered to All parties in the trial court (listed) FILING INSTRUCTIONS File original docketing statement and notice of appeal with all attachments listed in #7 and ONE copy of ALL except filing fee. Signature: COA-E-2 (rev. 8/10) American LegalNet, Inc. www.FormsWorkFlow.com