IN THE COURT OF APPEALS OF THE STATE OF ALASKA (for court system use) DOCKETING STATEMENT A FOR USE IN APPEALS UNDER APPELLATE RULE 204 FELONY MERIT APPEALS AND COMBINED FELONY MERIT/SENTENCE APPEALS 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 Will defendant seek co-counsel status in the appellate court? NO YES NO UNKNOWN d. Telephone * If defendant is incarcerated, include name and mailing address of correctional facility. 2. DEFENDANT’S ATTORNEY IN APPEAL a. Name Court Appt c. Attorney Mailing Address City b. Bar Number d. Telephone State Zip Code 3. DEFENDANT’S ATTORNEY IN TRIAL COURT a. Name Court Appt c. Attorney Mailing Address City Defendant not represented by attorney in appeal. f. Firm/Agency Same as attorney in appeal. Defendant not represented by attorney in trial court. b. Bar Number d. Telephone State Zip Code e. Fax 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 COA-A (rev. 8/10) DATE ORDER DISTRIBUTED Type of Post-Judgment Motion Month Day Year 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. Status 6. JUDGMENT OR ORDER BEING APPEALED a. Judgment (merit appeal or combined merit and sentence appeal). Provide the following information for each conviction being appealed. Count No. b. Offense NATURE OF APPEAL Conviction Conviction only and sentence PART OF SENTENCE BEING APPEALED Jail Fine Other (specify) Order. Specify: Order of dismissal. Order granting or denying post conviction relief (Criminal Rule 35.1). Order granting or denying motion to reduce or correct sentence (Criminal Rule 35(a) or (b)). Order granting or denying motion for new trial. Order granting or denying motion to withdraw plea. Order imposing attorney sanctions. Other. Specify nature of order: . 7. RELATED PROCEEDINGS IN APPELLATE COURT a. Pending Proceedings. List other pending proceedings in court of appeals or supreme court that involve defendant and arise out of the trial court case listed in 5.a. DATE OF FILING Month Day Year Pending Appellate Proceedings Appellate Court Case No. b. Prior Proceedings. List prior proceedings in court of appeals or supreme court that involved defendant and arose out of the trial court case listed in 5.a. DATE OF FILING Month Day Year COA-A-2 (rev. 8/10) Prior Appellate Proceedings Appellate Court Case No. American LegalNet, Inc. www.FormsWorkFlow.com 8. 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 statement of points on appeal. c. 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). an application for exemption from filing fee under AS 9.19.010. no filing fee is required because appellant is represented by court-appointed counsel, and AS 9.19.010 does not apply. the State of Alaska. d. A designation of transcript submitted. not submitted (no transcript being requested). motion to extend submitted. Date Signature of Appellant or Appellant’s Attorney 9. ATTORNEY INFORMATION* a. Name b. Bar Number c. Attorney Mailing Address d. Telephone City State 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 #8 and ONE copy of ALL except filing fee. Signature: COA-A-3 (rev. 8/10) American LegalNet, Inc. www.FormsWorkFlow.com