SAMPLE FORMS Form App. R. 9-1 Notice of Appeal IN THE INDIANA [SUPREME COURT/COURT OF APPEALS/TAX COURT] CAUSE NO. _____________________ NAME, ) ) [Appellant/Petitioner], ) [Appeal or Petition] from the ([Plaintiff/Defendant/Claimant/ ) [__________Court or Administrative Respondent below]), ) Agency] ) v. ) Trial Court [or Administrative ) Agency number] Case No.:________ NAME, ) ) The Honorable ________________, [Appellee/Respondent], ) Judge. ([Plaintiff/Defendant/Claimant/ ) Respondent below]). ) NOTICE OF APPEAL [insert whether this is an "expedited" appeal under App. R. 14.1] (Appearance) Party Information Name: ______________________________________________________ Address: _____________________________________________________ _____________________________________________________ The following party information only if not represented by an attorney: Tel. No.:______________________ Fax No.:________________ E-Mail: _________________________________ Requesting service of orders and opinions of the Court by: E-mail FAX or U.S. Mail (choose one) In forma pauperis: Yes No Attorney(s) representing party filing Notice of Appeal, if any: Name: ____________________________________________ Attorney # _________________________ Address: _____________________________________________________ _____________________________________________________ Tel. No.:_________________________ Fax No.:________________________ E-Mail: _________________________________ Name: ____________________________________________ Attorney # _________________________ Address: _____________________________________________________ _____________________________________________________ Tel. No.:_________________________ Fax No.:________________________ E-Mail: _________________________________ Name: ____________________________________________ Attorney # _________________________ Address: _____________________________________________________ _____________________________________________________ Tel. No.:_________________________ Fax No.:________________________ E-Mail: _________________________________ Name: ____________________________________________ Attorney # _________________________ 999999 / 1131839-1 American LegalNet, Inc. www.FormsWorkFlow.com Address: _____________________________________________________ _____________________________________________________ Tel. No.:_________________________ Fax No.:________________________ E-Mail: _________________________________ IMPORTANT: Each attorney specified above: (a) certifies that the contact information listed for him/her on the Indiana Supreme Court Roll of Attorneys is current and accurate as of the date of this Notice of Appeal; (b) acknowledges that all orders, opinions, and notices in this matter will be sent to the attorney at the email address(es) specified by the attorney on the Roll of Attorneys regardless of the contact information listed above for the attorney; and (c) understands that he/she is solely responsible for keeping his/her Roll of Attorneys contact information accurate, see Ind. Admis. Disc. R. 2(A). Attorneys can review and update their Roll of Attorneys contact information on the Clerk of Courts Portal at http://appealsclerk.in.gov. INFORMATION FOR JUDGMENT/ORDER BEING APPEALED Date of Judgment/Order being appealed: ______________________ Title of Judgment/Order being appealed: ______________________ Date Motion to Correct Error denied or deemed denied , if applicable: _____________ If case was heard by a magistrate, date trial judge approved judgment or order: ___________ Basis for Appellate Jurisdiction: Appeal from a Final Judgment, as defined by Appellate Rule 2(H) and 9(I) Appeal from an interlocutory order, taken as of right pursuant to Appellate Rule 14(A) or 14(D) Appeal from an interlocutory order, accepted by discretion pursuant to Appellate Rule 14(B)(3) or 14(C)(5) Expedited Appeal, taken pursuant to Appellate Rule 14.1 This appeal will be taken to: Court of Appeals of Indiana, pursuant to Appellate Rule 5 Indiana Supreme Court, pursuant to Appellate Rule 4 This is an appeal in which a sentence of death or life imprisonment without parole is imposed under Ind. Code § 35-50-2-9 or a post conviction relief case in which the sentence was death This is an interlocutory appeal authorized under Rule 14 involving the death penalty or a life without parole case raising a question of interpretation of Ind. Code § 35-502-9 This is an appeal from an order declaring a statute unconstitutional This is an appeal involving a waiver of parental consent to abortion under Rule 62 This is an appeal involving mandate of funds Trial Court Clerk/Administrative Agency/Court Reporter Instructions Pursuant to Appellate Rule 10 or 14.1(C), the clerk of [insert name of trial court or Administrative Agency] is requested to assemble the Clerk's Record, as defined in Appellate Rule 2(E). Pursuant to Appellate Rule 11 or 14.1(C), the court reporter of the [insert name of the court or Administrative Agency] is requested to transcribe, certify, and file with the clerk of the [insert name of trial court or Administrative Agency] the following hearings of record, including exhibits:_________________________________________________. Public Access Was the entire trial court or agency record sealed or excluded from public access? Yes No Was a portion of the trial court or agency record sealed or excluded from public access? Yes No If yes, which provision in Administrative Rule 9(G) provides the basis for this exclusion: _______________________________________________________________. If Administrative Rule 9(G) provides the basis for this exclusion, was the trial court or agency order 2 American LegalNet, Inc. www.FormsWorkFlow.com issued in accordance with the requirements of Administrative Rule 9(G)(4)? Yes No Appellate Alternative Dispute Resolution If civil case, is Appellant willing to participate in Appellate Dispute Resolution? Yes No If yes, provide a brief statement of the facts of the case. (Attach additional pages as needed.) _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Attachments The following SHALL be attached to this Notice of Appeal (in all appeals): Copy of judgment or order being appealed The following SHALL be attached to this Notice of Appeal i