TO BE FILED IN THE COURT OF APPEAL COURT OF APPEAL, ATTORNEY OR PARTY WITHOUT ATTORNEY: NAME: FIRM NAME: STREET ADDRESS: CITY: TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): STATE: FAX NO.: ZIP CODE: APP-004 COURT OF APPEAL CASE NUMBER (if known): APPELLATE DISTRICT, DIVISION STATE BAR NO: FOR COURT USE ONLY APPELLANT: RESPONDENT: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: JUDGES (all who participated in case): SUPERIOR COURT CASE NUMBER: CIVIL CASE INFORMATION STATEMENT NOTE TO APPELLANT: You must file this form with the clerk of the Court of Appeal within 15 days after the clerk mails you the notification of the filing of the notice of appeal required under rule 8.100(e)(1). You must attach to this form a copy of the judgment or order being appealed that shows the date it was entered (see Cal. Rules of Court, rule 8.104 for definition of "entered"). A copy of this form must also be served on the other party or parties to this appeal. (CAUTION: An appeal in a limited civil case (Code Civ. Proc., § 85) may be taken ONLY to the appellate division of the superior court (Code Civ. Proc., § 904.2) or to the superior court (Code Civ. Proc., § 116.710 [small claims cases]). A. APPEALABILITY 1. Appeal is from: Judgment after jury trial Judgment after court trial Default judgment Judgment after an order granting a summary judgment motion Judgment of dismissal under Code Civ. Proc., § 581d, 583.250, 583.360, or 583.430 Judgment of dismissal after an order sustaining a demurrer An order after judgment under Code Civ. Proc., § 904.1(a)(2) An order or judgment under Code Civ. Proc., § 904.1(a)(3)­(13) Other (describe and specify code section that authorizes this appeal): 2. Does the judgment appealed from dispose of all causes of action, including all cross-actions between the parties? Yes No (If no, please explain why the judgment is appealable): B. TIMELINESS OF APPEAL (Provide all applicable dates.) 1. Date of entry of judgment or order appealed from: 2. Date that notice of entry of judgment or a copy of the judgment was served by the clerk or by a party under California Rules of Court, rule 8.104: 3. Was a motion for new trial, for judgment notwithstanding the verdict, for reconsideration, or to vacate the judgment made and denied? Yes No (If yes, please specify the type of motion): Date motion denied: cross-appeal filed: Yes No Page 1 of 4 www.courts.ca.gov PART I ­ APPEAL INFORMATION Date notice of intention to move for new trial (if any) filed: Date motion filed: 4. Date notice of appeal or C. BANKRUPTCY OR OTHER STAY Is there a related bankruptcy case or a court-ordered stay that affects this appeal? (If yes, please attach a copy of the bankruptcy petition [without attachments] and any stay order.) Form Adopted for Mandatory Use Judicial Council of California APP-004 [Rev. January 1, 2017] Date denial served: CIVIL CASE INFORMATION STATEMENT (Appellate) American LegalNet, Inc. www.FormsWorkFlow.com APP-004 APPELLATE CASE TITLE: APPELLATE COURT CASE NUMBER: D. APPELLATE CASE HISTORY (Provide additional information, if necessary, on attachment I.D.) Is there now, or has there previously been, any appeal, writ, or other proceeding related to this case pending in any California appellate court? Yes No (If yes, insert name of appellate court): Appellate court case no.: Name of trial court: Title of case: Trial court case no.: E. SERVICE REQUIREMENTS Is service of documents in this matter, including a notice of appeal, petition, or brief, required on the Attorney General or other nonparty public officer or agency under California Rules of Court, rule 8.29 or a statute? Yes No (If yes, please indicate the rule or statute that applies) Rule 8.29 (e.g., constitutional challenge; state or county party) Bus. & Prof. Code, §16750.2 (Antitrust) Bus. & Prof. Code, § 17209 (Unfair Competition Act) Bus. & Prof. Code, § 17536.5 (False advertising) Civ. Code, § 51.1 (Unruh, Ralph, or Bane Civil Rights Acts; antiboycott cause of action; sexual harassment in business or professional relations; civil rights action by district attorney) Civ. Code, § 55.2 (Disabled access to public conveyances, accommodations, and housing) Code Civ. Proc., § 1355 (Escheat) Gov. Code, § 946.6(d) (Actions against public entities) Gov. Code, § 4461 (Disabled access to public buildings) Gov. Code, § 12656(a) (False Claims Act) Health & Saf. Code, § 19954.5 (Accessible seating and accommodations) Health & Saf. Code, § 19959.5 (Disabled access to privately funded public accommodations) Pub. Resources Code, § 21167.7 (CEQA) Other (specify statute): NOTE: The rule and statutory provisions listed above require service of a copy of a party's notice of appeal, petition, or brief on the Attorney General or other public officer or agency. Other statutes requiring service on the Attorney General or other public officers or agencies may also apply. PART lI ­ NATURE OF ACTION A. Nature of action (check all that apply): 1. 2. 3. 4. 5. 6. 7. 8. 9. Conservatorship Contract Eminent domain Equitable action a. Family law Guardianship Probate Real property rights a. Tort a. c. e. 10. 11. Declaratory relief b. Other (describe): Title of real property b. b. d. Other (describe): Product liability Personal property Medical malpractice Other personal injury Other tort (describe): Trust proceedings Writ proceedings in superior court Mandate (Code Civ. Proc., § 1085) a. c. Prohibition (Code Civ. Proc., § 1102) Other action (describe): b. d. Administrative mandate (Code Civ. Proc., § 1094.5) Other (describe): 12. B. This appeal is entitled to calendar preference/priority on appeal (cite authority): APP-004 [Rev. January 1, 2017] CIVIL CASE INFORMATION STATEMENT (Appellate) Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com APP-004 APPELLATE CASE TITLE: APPELLATE COURT CASE NUMBER: PART III ­ PARTY AND ATTORNEY INFORMATION In the spaces below or on a separate page or pages, list all the parties and all their attorneys of record who will participate in the appeal. For each party, provide all of the information requested on the left side of the page. On the right side of the page, if a party is self-represented please check the appropriate box and provide the party's mailing address, telephone number, fax number, and email address. If a party is represented by an attorney, on the right side of the page, check the appropriate box and provide all of the requested information about