AOC-070 Rev. 2-10 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov CR 76.03(3) COM M O NW E A LT H O F K E lex et justitia InternalUseOnly NT U C KY RT OF JUS TI KENTUCKyCOURTOFAPPEALS CIvILAPPEALPREHEARINgSTATEmENT C CO U E APPELLANT VS. COURTOFAPPEALSDOCKETNO._______________________________(leave blank) APPELLEE AppealFrom ___________________________ Circuit Court ActionNo. ___________________________________ Trial Judge: ________________________________ Judgment/Order Appealed From Entered: ___________________ Notice of Appeal Filed: _______________________ Notice of Cross Appeal Filed: _____________________________ Identifying Information Regarding Counsel for APPELLANT: Name of Client _______________________________________________________________________________ ___________________________________________________________________________________________ In the trial court, this party was the [ ] Plaintiff [ ] Defendant [ ] Other (specify) __________________________ Attorney's Name: _____________________________________________________________________________ Address: ____________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Telephone No. _________________________________ Identifying Information Regarding Counsel for APPELLEE: Name of Client _______________________________________________________________________________ ___________________________________________________________________________________________ In the trial court, this party was the [ ] Plaintiff [ ] Defendant [ ] Other (specify) __________________________ Attorney's Name: _____________________________________________________________________________ Address: ____________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Telephone No. _________________________________ 1. 2. 3. HasthiscasebeenbeforeanAppellateCourtpreviously? [ ] Yes [ ] No If Yes, provide date and prior case number(s) _____________________________________________________ Typeoflitigation (type of order; e.g., automobile negligence, breach of contract, domestic, product liability, property dispute, tax, UCC, zoning, etc.). AttachcopyofcomplaintorotherdocumentinitiatingCircuitCourtaction. _________________________________________________________________________________________ _________________________________________________________________________________________ Was this case mediated at the trial court level? [ ] Yes [ ] No American LegalNet, Inc. www.FormsWorkFlow.com AOC-070 Rev. 2-10 Page 2 of 2 4. 5. 6. 7. 8. 9. 10. CircuitCourtDisposition (type of order; e.g., Default or Summary Judgment, Dismissal, etc.). Attach copy of final judgmentandanyseparatewrittenopinionbytrialcourt. _________________________________________________________________________________________ _________________________________________________________________________________________ Relief: (a) Damages: AmountSought $ ____________________ Amountgranted $ _______________ (b) Injunction: [ ] Granted [ ] Denied (c) Other:______________________________________________________________________________ _____________________________________________________________________________________ FactsandIssues: (Brief statement of facts, claims, defenses and issues litigated. Attach separate sheet if necessary). _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Briefly state issuesproposedtoberaisedonappeal, including jurisdictional challenges, and any question of firstimpression.Attachseparatesheetifnecessary. _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Will the appeal turn on interpretation or application of a particularcaseorstatute? [ ] Yes [ ] No If Yes, identify case/statute: ___________________________________________________________________ Is there any known case involving substantiallythesameissuenowpending before either appellate court of this state? [ ] Yes [ ] No If Yes, give Case Number: __________________________________________ Case Name: ______________________________________________________________________________ Would a prehearing conference be helpful? [ ] Yes [ ] No Why? ______________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ CERTIFICATION I/We hereby certify a copy of the foregoing statement was executed and a copy served on: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Date: _________________, 2______. ______________________________________________ Signature Print Name: _________________________________________________________________________________ Address: ___________________________________________________________________________________ NOTES: 1)Items 2 and 4 on page 1 require documents to be attached to this Form for proper filing. 2)FilingofCivilNoticeofAppealsuspendsrunningoftimeforfurtherappealsteps-SeeCR76.03(3). 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