Form #App.R. 15-1 IN THE INDIANA [SUPREME COURT/ COURT OF APPEALS/TAX COURT] CAUSE NO. _____________________ NAME, [Appellant/Petitioner/ Plaintiff/Defendant,] v. NAME, [Appellee/Respondent/ Plaintiff/Defendant.] ) ) ) ) ) ) ) ) ) [Appeal or petition] from the _________ ____________________________ Court. Trial Court case no.: ______________ _________________________________ The Honorable ____________________ ___________________________, Judge. APPELLANT’S CASE SUMMARY (Appearance) Party Information Party or parties that filed Notice of Appeal: Name: ______________________________________________________ Address:_______________________________________________________________________________ The following party information only if not represented by an attorney: Tel. No.:_______________ Fax No.:________________ E-Mail: _________________________________ Requesting service of orders, opinions and notices of the Court by: E-mail , FAX , or U.S. Mail  (choose one) Attorney or attorneys representing party filing Notice of Appeal, if any [All fields, except FAX, MUST be supplied]: Name: ____________________________________________ Attorney # _________________________ Address:_______________________________________________________________________________ Tel. No.:_______________ Fax No.:________________ E-Mail: _________________________________ In forma pauperis: Yes [ ] No [ ] (if yes, attach proof of appointment or proof on indigency). Trial Information Date case commenced: ______________________ Date of Judgment/order:______________________ (Attach copy of judgment or order appealed from including findings and conclusions (civil) and sentencing order (criminal) Date Motion to Correct Error denied, or deemed denied, if used: (Attach copy of Motion to Correct Error) Was case heard by a judicial officer other than a judge? Yes  No  If yes, did the trial judge sign proposed judgment or order: Yes  No  Check the appropriate line(s) to show the ruling being appealed: Administrative ruling Declaratory judgment Directed verdict Dismissed Injunction Judgment (bench trial) Judgment (guilty plea) Judgment (jury verdict)  Judgment notwithstanding the verdict  Judgment (probation revocation)  Summary judgment Other (specify) ______________________________________________________________ Is this a final judgment as to all claims and all parties? Yes No If no, state the basis on which the judgment/order is immediately appealable. T.R. 54(B)  T.R. 56(C)  App.R. 14(A)(1-9)  App.R. 14(B)  App.R. 14(C)  App.R. 14(D)  Did the trial court issue an order sealing or excluding from public access all or any portion of the trial court records? Yes No If yes, attach copies of all orders and entries relating to the trial court’s decision to seal or exclude information from public access. Check the appropriate line(s) best describing the nature of the case: Attorney’s fees Child custody/support Education law Employment and labor Professional malpractice Real property rights American LegalNet, Inc. www.FormsWorkFlow.com Civil rights Construction law Contempt Contract law Corporate law Criminal law, Misdemeanor Criminal law, habitual felon Criminal law, probation revocation Criminal law, post conviction relief Specify ______________________ Debtor/creditor rights Dissolution of marriage Driver’s license revocation Environmental law Equitable distribution Guardianship Health care Insurance, auto Insurance, other Intentional torts Juvenile Landlord/tenant Municipal law Negligence Paternity Products liability Sanctions Taxation Termination of parental rights Tort claims act Unemployment compensation Unfair and deceptive practices Utilities Wills, trusts, estates Workers’ compensation Wrongful death Wrongful discharge Zoning/annexation Other_________________________________________________________________________________________ Synopsis of judgment and sentence, if applicable: _______________________________________ ________________________________________________________________________________ Record Information Date notice of appeal filed__________________ (Attach copy of notice of appeal) Date clerk’s record due to be assembled:__________________________________ Transcript information: Court reporter responsible for preparing transcript (Name, address, telephone number): _____________________________________________________________________ Transcript ordered: Yes  No Payment arrangements made: Yes No If no, reason not ordered or made: __________________________________________ ______________________________________________________________________ Est. Transcript length ____ pp. Transcript due date: ______________________________________________ Appeal Information A short and plain statement of the anticipated issues on appeal:___________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ (Attach copy of motion to correct errors) Prior appeals in this case with cause number: __________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Related appeals with Cause Number (prior, pending, or potential): _________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Motion for oral argument will be filed: Yes  No  Undecided  Motion for pre-appeal conference will be filed: No  Yes  Purpose: Shorten record  Appellate ADR  Refine issues  Other  If civil case, was ADR used in the trial court? Yes  No  If civil case, is Appellant willing to participate in Appellate ADR? Yes  No  If yes, provide a brief statement of the facts of the case. Attach additional pages as needed. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ If criminal case, status of defendant: On bond  Incarcerated  Location: __________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com I certify that this case does does not involve issues relating to child custody, child support, child visitation, paternity, termination of parental rights, CHINS, adoption, or any other issue entitled to priority by statute. I also certify that I have reviewed and complied, and will continue to comply, with the requirements of Indiana Administrative Rule 9(G)(4) to the extent it applies to this appeal. ____________________________________________ /s/ Attorney/or pro se litigant’s signature CERTIFICATE OF SERVICE I hereby certify that on this _______ day of _______________, 20_____, the forgoing was served upon the following counsel of record by [state method of service]: ________________________________________________________________________________________ ________________________________________________________________________________________ [List Counsel served (including name and address where served)]: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________ [Signature] American LegalNet, Inc. www.FormsWorkFlow.com