APP-104 Instructions · · Proposed Statement on Appeal (Limited Civil Case) Clerk stamps date here when form is filed. This form is only for preparing a proposed statement on appeal in a limited civil case. Before you fill out this form, read Information on Appeal Procedures for Limited Civil Cases (form APP-101-INFO) to know your rights and responsibilities. You can get form APP-101-INFO at any courthouse or county law library or online at www.courts.ca.gov/forms. This form can be attached to your Appellant's Notice Designating Record on Appeal (Limited Civil Case) (form APP-103). If it is not attached to that notice, this form must be filed no later than 20 days after you file that notice. If you have chosen to prepare a statement on appeal and do not file this form on time, the court may dismiss your appeal. Fill out this form and make a copy of the completed form for your records and for each of the other parties. Serve a copy of the completed form on each of the other parties and keep proof of this service. You can get information about how to serve court papers and proof of service from What Is Proof of Service? (form APP-109-INFO) and on the California Courts Online Self-Help Center at www.courts.ca.gov/selfhelp-serving.htm. Take or mail the original completed form and proof of service on the other parties to the clerk's office for the same court that issued the judgment or order you are appealing. It is a good idea to take or mail an extra copy to the clerk and ask the clerk to stamp it to show that the original has been filed. 1 You fill in the number and name of the trial court case in which you are appealing the judgment or order: You fill in the name and street address of the court that issued the judgment or order you are appealing: · Superior Court of California, County of · · Trial Court Case Number: Trial Court Case Name: · You fill in the appellate division case number (if you know it): Appellate Division Case Number: Your Information a. Name of Appellant (the party who is filing this appeal): Name: b. Appellant's contact information (skip this if the appellant has a lawyer for this appeal): Street address: Street City Street City State State Zip Zip Mailing address (if different): Phone: E-mail: c. Appellant's lawyer (skip this if the appellant does not have a lawyer for this appeal): Name: Street address: Street City Street City State State Zip Zip State Bar number: Mailing address (if different): Phone: Fax: Judicial Council of California, www.courts.ca.gov Revised January 1, 2017, Optional Form Cal. Rules of Court, rule 8.837 E-mail: Proposed Statement on Appeal (Limited Civil Case) APP-104, Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Trial Court Case Number: Trial Court Case Name: Information About Your Appeal 2 On (fill in the date): in the box on page 1 of this form. On (fill in the date): to use a statement on appeal. , I/my client filed a notice of appeal in the trial court case identified , I/my client filed a notice designating the record on appeal, electing 3 Proposed Statement 4 Reasons for Your Appeal Remember, in an appeal, the appellate division can only review a case for whether certain kinds of legal errors were made (read form APP-101-INFO to learn about these legal errors): · There was not "substantial evidence" supporting the judgment, order, or other decision you are appealing. · A "prejudicial error" was made during the trial court proceedings. The appellate division: · Cannot retry your case or take new evidence. · Cannot consider whether witnesses were telling the truth or lying. · Cannot consider whether there was more or stronger evidence supporting your position than there was supporting the trial court's decision. (Check all that apply and describe the legal error or errors you believe were made that are the reason for this appeal.) a. There was not substantial evidence that supported the judgment, order, or other decision that I/my client indicated in the notice of appeal is being appealed in this case. (Explain why you think the judgment, order, or other decision was not supported by substantial evidence): b. The following error or errors about either the law or court procedure was/were made that caused substantial harm to me/my client. (Describe each error and how you were/your client was harmed by that error.) (1) Describe the error: Describe how you were/your client was harmed by the error: Revised January 1, 2017 Proposed Statement on Appeal (Limited Civil Case) APP-104, Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Trial Court Case Number: Trial Court Case Name: (2) Describe the error: Describe how you were/your client was harmed by the error: (3) Describe the error: Describe how you were/your client was harmed by the error: Check here if you need more space to describe these or other errors and attach a separate page or pages describing the errors. At the top of each page, write "APP-104, item 4." 5 The Dispute a. In the trial court, I/my client was the (check one): plaintiff (the party who filed the complaint in the case). defendant (the party against whom the complaint was filed). b. The plaintiff's complaint in this case was about (briefly describe what was claimed in the complaint filed with the trial court): c. The defendant's response to this complaint was (briefly describe how the defendant responded to the complaint filed with the trial court): Check here if you need more space to describe the dispute and attach a separate page or pages describing it. At the top of each page, write "APP-104, Item 5." Revised January 1, 2017 Proposed Statement on Appeal (Limited Civil Case) APP-104, Page 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Trial Court Case Number: Trial Court Case Name: 6 Summary of Any Motions and the Court's Order on the Motion a. Were any motions (requests for the trial court to issue an order) made in this case that are relevant to the reasons you gave in 4 for this appeal? Yes (fill out b) No (skip to 7 ) b. In the spaces below, describe any motions (requests for orders) that were made in the trial court that are relevant to the reasons you gave in 4 for this appeal. Write a complete and accurate summary of what was said at any hearings on these motions and indicate how the trial court ruled on these motions. (1) Describe the first motion: The motion was filed by the There was plaintiff. defendant. was not a hearing on this motion. If there was a hearing on this motion