FIFTH DISTRICT COURT OF APPEAL DOCKETING STATEMENT AND NOTICE OF APPEARANCE OF COUNSEL FAILURE TO RETURN STATEMENT MAY RESULT IN SANCTIONS The Court requires the following information in order to facilitate disposition of the case. This form is also available at www.5dca.org APPELLANT/PETITIONER: If this case involves an original writ, is an appeal of a non-final order or is a case involving child custody, this docketing statement must be completed and returned within five days. In all other cases, the appellant must file the docketing statement within 10 days from the date of the acknowledgment of the notice of appeal. APPELLEE/RESPONDENT: Is not required to file a docketing statement unless there are amendments, corrections or additions to the docketing statement filed by the appellant/petitioner. Appellee/respondent is only required to file a notice of appearance if counsel's name does not already appear on the certificate of service. Appellee's/respondent's docketing statement, if necessary, is due within 5 days from service of the appellant's/petitioner's docketing statement. PLEASE PROVIDE THE FOLLOWING INFORMATION: DOCKETING STATEMENT OF: (CHECK ONE) ______ ______ 1. STYLE OF CASE DCA CASE NUMBER APPELLANT/PETITIONER APPELLEE/RESPONDENT LOWER COURT CASE NUMBER 2a. NOTICE OF APPEARANCE OF COUNSEL FOR APPELLANT (If party is not represented by counsel, party should so indicate and provide accurate mailing address and phone number). Name____________________________________________________ Bar Number_________________ Address_____________________________________________________________________________ Attorney For__________________PhoneNumber__________________FaxNumber_________________ ______________________________________ __________ 2b. APPELLEE'S TRIAL COUNSEL AND/OR APPELLATE COUNSEL (IF KNOWN) Name____________________________________________________ Bar Number_________________ Address_____________________________________________________________________________ Attorney For__________________PhoneNumber__________________FaxNumber_________________ 1 rev. 0810 American LegalNet, Inc. www.FormsWorkFlow.com 3. INTERESTED PERSONS: List names of all persons or entities having an interest in this matter. Please clarify whether these persons or entities are parties, lawyers or otherwise, and as to parties, designate whether appellant or appellee. 4. JUDGES BELOW: List the name of all judges, deputy commissioners and hearing officers/examiners who were involved in this action below. Specify the judge who entered the order appealed. 5. JURISDICTION: State the basis for this court's jurisdiction, including the following: (1) the appellate rule providing jurisdiction claimed________________________________; (2) the date of filing in the lower tribunal of the order appealed ______________________; (3) if this is an appeal from a final order, the date of the return of verdict in a jury action _________________, the service date of any motion tolling rendition of the final order under Fla. R. App. P. 9.020(h)________________and the date of entry of the order deciding such motion _________________. (A certified copy of such motion shall be attached) 6. PENDING MATTERS IN LOWER TRIBUNAL: Are there any matters, including counts of claims or counterclaims, still pending in the lower tribunal? If yes, please explain exactly what remains pending. 7. SIMILAR ISSUES: List by this Court’s style and case number any cases that are pending that involve an issue similar to the issue(s) in this case. If you become aware of any such case during the pendency of this appeal, you have a continuing duty to inform the Court promptly. Certificate of Service I certify that a copy hereof has been furnished by _______________ this _____ day mail / hand delivery of ____________________________________________________________,20____, to: _______________________________________________________________________. _________________________________ Attorney/Party (Signature) _________________________________ (Print Name) 2 rev. 0810 American LegalNet, Inc. www.FormsWorkFlow.com