Summary to Accompany Application for Leave to File Appeal by County Attorney - § 29-2315.01 The Nebraska Supreme Court requires that this form be filed as part of an application by a county attorney requesting leave to file an appeal pursuant to Neb. Rev. Stat. § 29-2315.01 and Neb. Ct. R. § 2-115(2). This form is only a synopsis of the action in the case, and is not a substitute for any pleading or application required by statute. Answers may be continued on an attached sheet of paper. 1. Name, address, and telephone number of attorney presenting application: 2. County where case filed: 4. Case Caption: 3. Name of district judge: STATE v. 5. Charge(s) filed against defendant: 6. Description of order for which review is sought: 7. Date order entered: 8. Summary of the basis or reasons for the application: 9. Brief, concise statement of facts: 10. Description of the public interest to be protected by this review: 11. Portion of record to be presented for review: 12. Date application presented to judge: 13. Date application signed: APPENDIX 4 Page 1 of 1 Summary to Accompany Application for Leave to File Appeal by County Attorney Ch2Art1App4 Effective 12/21/2016 Ch. 2, Art. 1, App. 4 American LegalNet, Inc. www.FormsWorkFlow.com