STATE OF MINNESOTA IN COURT OF APPEALS CASE TITLE: _____________________________, Relator (your name) STATEMENT OF CASE OF RELATOR vs. COURT OF APPEALS #: _____________________________, Respondent (employer’s name), DEPARTMENT OF EMPLOYMENT & ECONOMIC DEVELOPMENT #: Department of Employment & Economic Development, Respondent. 1. Agency of case origination. Department of Employment and Economic Development 2. Jurisdictional statement. Certiorari appeal. Statute authority authorizing certiorari appeal and fixing time limit for appeal: Minn. Stat. § 268.105, subd. 7(a) 3. State type of litigation and designate any statutes at issue. Unemployment insurance, Minn. Stat. ch. 268 4. Short description of issues raised to the unemployment law judge: _______________________________________________________________ _______________________________________________________________. 5. Short description of issues you are raising in this appeal. (This is meant to be a short outline of your argument. You can make a detailed argument in the brief you will file with this court later.) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkflow.com 6. List any other related appeals. _________________________________________________________________ 7. Was testimony given at the hearing conducted by the unemployment law judge? _____ Yes _____ No If testimony was given, the Department of Employment and Economic Development will send you a transcript. If no testimony was given, there is no transcript to send. 8. Oral argument. Only attorneys can make oral arguments. If you do not have an attorney, neither you nor respondents will have oral argument. If you have an attorney, is oral argument requested? _____ Yes _____ No If yes, state where oral argument is requested: ___________________________ 9. Identify the type of brief to be filed: ( ) Formal brief under rule 128.02 A formal brief includes a table of contents, a statement of legal issues, a statement of the case, facts, an argument, a conclusion, and an appendix (see rule 128.02). A formal brief must be bound (see rule 132.01). ( ) Informal brief under rule 128.01, subd. 1 An informal brief contains a concise statement of your argument. It may be stapled. ( ) Trial memoranda, supplemented by a short letter argument under rule 128.01, subd. 2 All briefs must contain an appendix that includes at least a copy of the petition and writ of certiorari and a copy of the decision that you are appealing. 10. Names, addresses, zip codes and telephone numbers of relator and respondent (or attorneys, if any). Relator: Print name: ______________________________________________ Address: ______________________________________________ ______________________________________________ Telephone: ______________________________________________ Signature: ______________________________________________ 2 American LegalNet, Inc. www.FormsWorkflow.com Employer (or attorney): Name: ______________________________________________ Address: ______________________________________________ ______________________________________________ Telephone: ______________________________________________ Atty. Reg. #: ______________________________________________ DEPARTMENT OF EMPLOYMENT & ECONOMIC DEVELOPMENT E200 First National Bank Building 332 Minnesota Street St. Paul, MN 55101 MINNESOTA ATTORNEY GENERAL 900 Bremer Tower 445 Minnesota Street St. Paul, MN 55101-2127 3 American LegalNet, Inc. www.FormsWorkflow.com