IN THE COURT OF APPEALS OF THE STATE OF ALASKA (for court system use) DOCKETING STATEMENT C FOR USE IN EXPEDITED APPEALS UNDER APPELLATE RULE 216 AND JUVENILE APPEALS UNDER APPELLATE RULE 219 Appeal filed by Defendant State of Alaska 1. TYPE OR APPEAL a. Extradition Appeal (App. R. 216(a)(1) b. Preemptory Challenge Appeal (App. R. 216(a)(2) c. Juvenile Delinquency Appeal (App. R. 219(a)(1) d. No. Juvenile Waiver Appeal (App. R. 219(a)(2) 2. DEFENDANT (If defendant is juvenile, use initials.) 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. 3. DEFENDANT’S ATTORNEY IN APPEAL a. Name Court Appt c. Attorney Mailing Address City Defendant not represented by attorney in appeal. b. Bar Number d. Telephone State Zip Code f. Firm/Agency Same as attorney in appeal. Defendant not represented by attorney in trial court. 4. DEFENDANT’S ATTORNEY IN TRIAL COURT a. Name b. Bar Number c. Attorney Mailing Address City e. Fax d. Telephone State Zip Code e. Fax f. Firm/Agency 5. 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. 6. EXTRADITION APPEAL a. Superior Court Case No. b. Superior Court Judge d. Offense(s) for which extradition sought: f. Pending Charges in Alaska COA-C (rev. 8/10) c. Date Order or Judgment Distributed e. Requesting State Trial Court Case No. Status of Case American LegalNet, Inc. www.FormsWorkFlow.com 7. PEREMPTORY CHALLENGE APPEAL a. Trial Court Case No. b. Judge Who is the Subject of Challenge f. Pending Charges in Alaska e. Pending Charges in Trial Court YES c. Date Order or Judgment Distributed NO ) 8. JUVENILE APPEAL (DOB: a. Superior Court Case No. b. Superior Court Judge c. Date Order Distributed d. Juvenile Delinquency Appeal e. Juvenile Waiver Appeal. Nature of Appeal adjudication only disposition only adjudication and disposition Part of disposition being appealed List Underlying Charges(s) Institutional Commitment Probation Other. Specify . 9. ATTACHMENTS The following items are submitted with this form: a. A copy of the final order or judgment from which the appeal is taken. 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). no filing fee is required because appellant is d. For juvenile appeal only: A designation of cassette tapes represented by court-appointed counsel, the state or an agency thereof. submitted. not submitted (no cassette tapes being requested). motion to extend submitted. Date Signature of Appellant or Appellant’s Attorney 10. 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 #9 and ONE copy of ALL except filing fee. Signature: COA-C-2 (rev. 8/10) American LegalNet, Inc. www.FormsWorkFlow.com