COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: CRIMINAL (DEFENDANT APPEAL/POST-CONVICTION RELIEF) /1/2017 This criminal cover sheet is required by Supreme Court Administrative Order 8. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are located at www..gov. County: District: Filing Date: Judge: Division: Case ID: Does the person appealing or seeking relief have other active cases? Yes No Case IDs: Previous case ID (of the case being appealed or conviction/sentence being challenged): New case type: (MA) Misdemeanor Appeal Reopen existing case: (MFREW) Reopen for Extraordinary Writ (MFR+ original case type) Reopen for other post-conviction relief Person initiating appeal/post-conviction relief: First: Middle: Last: Suffix: DOB: DLN or State ID: State: SID#: ATN: Alias 1: Alias 2: Arrest date: Address: City: State: ZIP: Race: Ethnicity: Hispanic Non-Hispanic Sex: Male Female Does the person seeking the appeal/post-conviction relief have an attorney for this case? Yes - Name: Bar #: No (This person is self-represented) Does this person need an interpreter? Yes No Language: Other: Convictions being appealed (for misdemeanor appeal): Code # Offense name/Description A/S/C Offense Date Counts M/V Class American LegalNet, Inc. www.FormsWorkFlow.com