UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF IOWA OFFICE OF THE CLERK P. O. BOX 9344 DES MOINES, IA. 50306-9344 515-284-6248 COUNSEL FOR APPELLANT PLEASE COMPLETE AND SUBMIT WITH NOTICE OF APPEAL Civil Case Notice of Appeal Supplement Case Name: _____________________________ vs. _________________________________ District Court Case # ____:____- cv - _________ Appeal Fee ($455.oo) Status Pd Counsel Appointed Appeal filed by Counsel CJA IFP Retained Pro Se Pending Pro Se Govt. Appeal Any reason why counsel should not be appointed___________________________________ Pending post Judgment motions: Yes No Type of Motion(s)_____________________________________________________________ High Public Interest Case Yes No No Simultaneous Opinion Release Requested Yes Trial Held Yes Jury Trial Held Yes Court Reporter Yes No No No Length of Trial _________________ Reporter's Name ___________________________ Address ___________________________________ ____________________________________________ Phone ____________________ Transcript Ordered Yes No Final Judgment Appealing: Order prior to final judgment Completed Form "A" Enclosed Yes No American LegalNet, Inc. www.FormsWorkFlow.com