Michigan Court of Appeals DOCKETING STATEMENT Case No: Circuit: Court of Appeals: Please read before completing form. MCR 7.204(H) and 7.205(D)(3) require an appellant in a civil action to complete and file a docketing statement within 28 days after the claim of appeal is filed or the application for leave to appeal is granted. Failure to timely file this document may lead to dismissal of the appeal. An appellee may respond by filing a separate docketing statement. This document will be used to screen the appeal for suitability and eligibility for the settlement conference program, and will be used to help resolve jurisdictional and transcript issues. It is important that you complete this form accurately and legibly. The issues identified in the docketing statement do not limit appellant's presentation of the issues in appellant's brief. Omission of an issue in the docketing statement will not provide a basis for a motion to strike appellant's brief. 1. Case Name: Appellant Appellee _____________________________________ v Name of first Plaintiff Appellant Appellee ______________________________________ Name of first Defendant Address: Address: Telephone No: Telephone No: Attorney Name: Bar No:_______ Attorney Name: Address: Address: Telephone No: Bar No:_______ Telephone No: 2. A bankruptcy or other proceeding has been filed which affects this Court's jurisdiction over this appeal. Identify and explain. 3. There are pending or prior appeals in the Court of Appeals or Supreme Court which arose out of the same transaction, lower court case, or between the same parties. Specify case name, lower court number, appellate court number(s), and citation, if available. 4. I am aware of the following pending appeals in the Court of Appeals or Supreme Court raising the same or closely related issues. Specify case name, lower court number, appellate court number(s), and citation, if available. 1 American LegalNet, Inc. www.FormsWorkflow.com 5. Identify all the lower court hearings. Type of proceeding (i.e. motion, trial, etc.) Date(s) Occurred Court Reporter 6. Nature of case: a. If the lower court case number provided on page 1 does not include a suffix, please specify the circuit court case code (i.e. NI, CK, etc): ______________________________. b. Identify the procedural nature of the case being appealed. arbitration bench trial post-judgment action declaratory judgment interlocutory matter jury trial summary disposition administrative proceeding (specify agency) _______________________________________ other (i.e. default judgment)____________________________________________________ 7. Briefly describe the nature of the action and the result in the trial court. Conclusory statements such as "the judgment of the trial court is not supported by law" are unacceptable. Attach additional pages as needed. 8. Briefly state the issues to be raised in this appeal. Attach additional pages as needed. 9. The amount and terms of the judgment appealed are: 10. Settlement negotiations. (Check all boxes that apply.) Settlement negotiations have been conducted or are scheduled. Settlement is unlikely. Other ______________________________________________________________________________ ________________ _________________________________ Date Signature Provide the Proof of Service on a separate form. 2 American LegalNet, Inc. www.FormsWorkflow.com