IN THE SUPREME COURT OF THE STATE OF ALASKA (for court system use) DOCKETING STATEMENT A For Use in Appeals Under Appellate Rule 204 and 218 INSTRUCTIONS FOR MULTIPLE PARTIES OR ATTORNEYS: If there are multiple parties or attorneys, repeat the appropriate box. This may be done on a separate page. Please clearly indicate which attorney represents which party. 1. TYPE OF APPEAL No. a. General Civil Rule Appeal (App. Rule 204) b. Appeal in Child Custody Case (App. Rule 218) 2. PARTY FILING APPEAL (Appellant) b. Status in the Trial Court Plaintiff a. Name c. Party Mailing Address (not attorney’s address) City State Defendant Other. Specify: Zip Code . d. Telephone 3. APPELLANT’S ATTORNEY a. Name b. Bar Number c. Attorney Mailing Address d. Telephone City State Zip Code e. Fax f. Firm/Agency 4. PARTY APPEALED AGAINST (Appellee) [All parties in the trial court when the final order/judgment were entered are appellees and must be listed if they did not file a notice of appeal. AR 204(b)[1] & (g).] a. Name b. Status in the Trial Court Plaintiff Defendant c. Party Mailing Address Other. Specify: City State Zip Code . d. Telephone 5. APPELLEE’S ATTORNEY a. Name b. Bar Number c. Attorney Mailing Address d. Telephone City State Zip Code e. Fax f. Firm/Agency 6. SUPERIOR COURT PROCEEDING a. Case No. b. Superior Court 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)(3). DATE OF FILING Month Day Year DATE ORDER DISTRIBUTED Type of Post-Judgment Motion Month Day Year 7. CONSTITUTIONAL ISSUES Is the constitutionality of a state statute or regulation at issue in this appeal? If yes, cite statute or regulation: SCT-A (rev. 10/10) Yes No American LegalNet, Inc. www.FormsWorkFlow.com 8. FINALITY OF JUDGMENT OR ORDER BEING APPEALED a. The judgment or order being appealed is final and disposes of ALL claims by ALL parties. (The judgment or order is final under City and Borough of Juneau v. Thiboudeau 595 P.2d 626 (AK 1979).) The judgment or order being appealed does not dispose of all claims by all parties but is final under Civil Rule 54(b). (The trial court’s Civil Rule 54(b) order must be attached.) b. c. The judgment or order being appealed is not final. The authority for this appeal is 9. ATTACHMENTS The following items are submitted with this form (except that cross-appellants need not submit item a.): 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 (if basis for motion is inability to pay, 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 or an agency thereof. an employee appealing denial of benefits under AS 23.20 (Employment Security Act) d. A $750 cost bond or deposit or a copy of a superior court order approving appellant’s supersedeas bond or a copy of appellant’s motion to the superior court for approval of a supersedeas bond. a motion to wave cost bond (if basis for motion is inability to pay, financial statement affidavit form must be included). a motion to appeal at public expense (financial statement affidavit form must be included.) no cost bond is required because appellant is represented by court-appointed counsel. a state agency, municipality, or state or municipal officer. an employee appealing denial of compensation by Alaska Workers’ Compensation Board or denial of benefits under AS 23.20 (Employment Security Act). e. Designation of transcript submitted Date not submitted (no transcript being requested) motion to extend submitted Signature of Appellant or Appellant’s Attorney CERTIFICATE OF SERVICE I certify that on a copy of the notice of appeal, this docketing statement, and all attachments (except filing fee and cost bond) were mailed delivered Signature: SCT-A-2 (rev. 10/10) to All Parties (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 and cost bond. American LegalNet, Inc. www.FormsWorkFlow.com