IN THE ________________________________________ (Court or Agency From Which Appeal is Taken) TH IS S P AC E FO R O FFIC E U S E O N LY CIVIL APPEAL DOCKETING STATEMENT (For Use By The Appellate Mediation Program) PLEASE ATTACH ADDITIONAL PAGES IF NECESSARY. TITLE Trial Court/Agency Docket Number: Is this a Cross-Appeal? Yes No Has this matter previously been before the Hawai'i Appellate Courts? Yes No If yes, state when: Case Name: Docket Number: CHECK AS MANY AS APPLICABLE TRIAL COURT/AGENCY DISPOSITION 1. () () () STAGE OF PROCEEDINGS Pre-Trial During Trial After Trial () 2. () RELIEF Damages: Amount Sought: $_ _________ Amount Granted: $ __________ Other (Specify) DESCRIPTION OF NATURE OF ACTION AND RESULT IN THE TRIAL COURT OR AGENCY: HRAP Form 6 (Rev. 09/11) Reprographics (12/2013) CommonLook® 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com SC-P-336 ANTICIPATED ISSUES PROPOSED TO BE RAISED ON APPEAL: DOES THIS APPEAL INVOLVE ANY OF THE FOLLOWING: Likelihood of a motion to expedite the appeal. Likelihood of motions to stay appeal pending resolution of a related case. Identify case name, docket number, and court or agency: Other procedural complexities. If so, please identify them: Appellants' Names: COUNSEL FOR APPELLANTS: NAME: ADDRESS: TELEPHONE ( EMAIL: ) TRIAL COUNSEL FOR APPELLANT(S) (If different from appeal counsel) NAME: ADDRESS: TELEPHONE ( EMAIL: ) Page 2 HRAP Form 6 (Rev. 09/11) American LegalNet, Inc. www.FormsWorkFlow.com SC-P-336 I CERTIFY THAT A COPY OF THIS CIVIL APPEAL DOCKETING STATEMENT WAS SERVED ON EACH PARTY/COUNSEL SHOWN ON THE ATTACHED SERVICE LIST. _________________________________________________ Signature ________________________________ Date REMEMBER TO ATTACH COPIES OF: (1) THE ORDER/JUDGMENT APPEALED FROM; (2) ANY WRITTEN OPINION OR FINDINGS OF FACT AND CONCLUSIONS OF LAW SUPPORTING THE ORDER/JUDGMENT; AND (3) PROOF OF SERVICE ON ALL OTHER PARTIES TO THE TRIAL COURT OR AGENCY PROCEEDINGS (WITH TELEPHONE NUMBERS AND EMAIL ADDRESSES) Page 3 HRAP Form 6 (Rev. 09/11) American LegalNet, Inc. www.FormsWorkFlow.com SC-P-336