IN THE _________________________ COURT _______________COUNTY, OHIO ___________________________ Plaintiff v. ___________________________ Defendant Trial Ct. Case No. __________________ Appellate Case No. _________________ STATEMENT AND PRAECIPE (Agreed Statement) TO THE APPELLEE: The appellant hereby states that in lieu of the record on appeal as defined by Appellate Rule 9(A) the cause will be submitted on appeal on an agreed statement of the case (Appellate Rule 9(D)). TO THE CLERK: Delivered to you herein is a statement of the case agreed to by the parties or their counsel, together with such additions as the trial court may consider necessary, and approved by the trial court (Appellate Rule 9(D)). Immediately (and no later than the fortieth day after the filing of the notice of appeal, or within the time for filing the record set forth in the accelerated calendar scheduling order, or no later than the last day of a proper extension of the time for transmission of the record) certify this agreed statement of the case to the Court of Appeals of this county to constitute the record on appeal in lieu of the record defined by Appellate Rule 9(A) and transmit same to the clerk of that court for file in case number therein. __________________________________ __________________________________ __________________________________ __________________________________ American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that a copy of this Statement and Praecipe was served by regular mail upon ______________________________________________________________________________ ___________________________________________________ this ____ day of ____________, 20__. __________________________________ American LegalNet, Inc. www.FormsWorkFlow.com