Form 2. Case Appeal Statement No. Dept. No. . IN THE ................ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF ................ A. B., Plaintiff } v. } C. D., Defendant } CASE APPEAL STATEMENT 1. Name of appellant filing this case appeal statement: 2. Identify the judge issuing the decision, judgment, or order appealed from: 3. Identify all parties to the proceedings in the district court (the use of et al. to denote parties is prohibited): 4. Identify all parties involved in thisppeal (the use of et al a . to denote parties is prohibited): 5. Set forth the name, law firm, address, and telephone number of all counsel on appeal and identify the party or parties whom they represent: 6. Indicate whether appellant was represented by appointed or retained counsel in the district court: 7. Indicate whether appellant is represented by appointed or retained counsel on appeal: 8. Indicate whether appellant was granted leave to proceed in forma pauperis, and the date of entry of the district court order granting such leave: 9. Indicate the date the proceedings commenced in the district court (e.g., date complaint, indictment, information, or petition was filed): Dated this .. day of ., 20. . .. ( Signature of Attorney) .. (Nevada Bar Identification No.) .. ( Law Firm) .. ( Address) .. (Telephone Number)