LOUISIANA COURT OF APPEAL, FIFTH CIRCUIT WRIT APPLICATION INTAKE FORM Adopted on 5/23/2014 by Court en banc CASE TITLE _____________________________________________________________________________________ Versus __________________________________________________________________________________________________ EXPEDITED CONSIDERATION Is Expedited Consideration being requested? Stay requested at a district court? Yes No - If no, move to District Court Information. Denied N/A Granted until________________________ Yes No Is a Stay Order being requested from the Fifth Circuit? Case Status: Pre-Trial Jury Trial Trial in Progress Bench Trial Next Hearing or Trial Set ____________________________ Date / Time Post-Trial What is the nature of the request for expedited consideration? ________________________________________________ __________________________________________________________________________________________________ DISTRICT COURT INFORMATION Case Type (please check all that apply) Criminal Civil Family Juvenile Trial Judge ______________________________________ Date Ruling was Rendered ___________________________ Briefly explain purpose of writ ________________________________________________________________________ __________________________________________________________________________________________________ SEALED RECORD INFORMATION To your knowledge, is any portion of this application under seal by the lower court? Yes No If yes, please indicate the portion of the record sealed and include the lower court order with the application. Are you requesting that any portion of this application be sealed? If yes, a request for such must be included with the application. Yes No PRIOR / PENDING CASE INFORMATION To your knowledge, have there been other filings, appeals / writ applications in this Court in this matter? Yes No If yes, please specify. ________________________________________________________________________________ To your knowledge, are there any appeals or applications for supervisory review related to the present matter currently pending before this court? Yes No If yes, please specify. ________________________________________________________________________________ To your knowledge, would any of the matters currently pending in this court impact the current filing or will the current filing impact any of the matters pending? Yes No If yes, please explain. ________________________________________________________________________________ __________________________________________________________________________________________________ To your knowledge, has this pleading been filed simultaneously in any other court? Yes No If yes, please explain. _______________________________________________________________________________ I, undersigned counsel, certify that the above information and all of the information contained in this application is true and correct to the best of my knowledge and that all relevant pleadings, and rulings, as required by Uniform Rules 4-2, 4-3, 4-4, and 4-5 of the Courts of Appeal are attached to this filing. I further certify that a copy of this application has been mailed or delivered to the respondent judge and to all other counsel and unrepresented parties required by Uniform Rule 4-5. I understand that failure to comply with Uniform Rules 4-2, 4-3, 4-4, and 4-5 may result in the dismissal or denial of my application. I SHALL IMMEDIATELY NOTIFY THE COURT IF THE NEED FOR EXPEDITED CONSIDERATION CHANGES DUE TO SETTLEMENT, CONTINUANCE OR ANY OTHER CIRCUMSTANCE. FAILURE TO NOTIFY THE COURT MAY SUBJECT ME TO PUNISHMENT FOR CONTEMPT OF THE AUTHORITY OF THE COURT. ____________ Date ________________________ ________________________________ Print Name Signature / Bar Roll No. ________ ________ Best Contact No. American LegalNet, Inc. www.FormsWorkFlow.com