UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT CIVIL APPEAL PRE-ARGUMENT STATEMENT (FORM C) 1. SEE NOTICE ON REVERSE Case Caption: 2. PLEASE TYPE OR PRINT District Court or Agency: 3. STAPLE ALL ADDITIONAL PAGES Judge: Date the Order or Judgment Appealed from was Entered on the Docket: District Court Docket No.: Date the Notice of Appeal was Filed: Is this a Cross Appeal? 9 Yes 9 No Attorney(s) for Appellant(s): 9 Plaintiff 9 Defendant Counsel's Name: Address: Telephone No.: Fax No.: E-mail: Attorney(s) for Appellee(s): 9 Plaintiff 9 Defendant Counsel's Name: Address: Telephone No.: Fax No.: E-mail: Has Transcript Been Prepared? Approx. Number of Transcript Pages: Number of Exhibits Appended to Transcript: Has this matter been before this Circuit previously? If Yes, provide the following: Case Name: 2d Cir. Docket No.: 9 Yes 9 No Reporter Citation: (i.e., F.3d or Fed. App.) ADDENDUM "A": COUNSEL MUST ATTACH TO THIS FORM: (1) A BRIEF, BUT NOT PERFUNCTORY, DESCRIPTION OF THE NATURE OF THE ACTION; (2) THE RESULT BELOW; (3) A COPY OF THE NOTICE OF APPEAL AND A CURRENT COPY OF THE LOWER COURT DOCKET SHEET; AND (4) A COPY OF ALL RELEVANT OPINIONS/ORDERS FORMING THE BASIS FOR THIS APPEAL, INCLUDING TRANSCRIPTS OF ORDERS ISSUED FROM THE BENCH OR IN CHAMBERS. ADDENDUM "B": COUNSEL MUST ATTACH TO THIS FORM A LIST OF THE ISSUES PROPOSED TO BE RAISED ON APPEAL, AS WELL AS THE APPLICABLE APPELLATE STANDARD OF REVIEW FOR EACH PROPOSED ISSUE. PART A: JURISDICTION 1 . Federal Jurisdiction 9 9 U.S. a party Federal question (U.S. not a party) 9 Diversity 9 Other (specify): 9 9 Final Decision Interlocutory Decision Appealable As of Right 2 . Appellate Jurisdiction 9 Order Certified by District Judge (i.e., Fed . R. Civ. P. 54(b)) 9 Other (specify): IMPORTANT. COMPLETE AND SIGN REVERSE SIDE OF THIS FORM. FORM C (Rev. October 2016) American LegalNet, Inc. www.FormsWorkFlow.com PART B: DISTRICT COURT DISPOSITION 1. Stage of Proceedings 9 9 9 Pre-trial During trial After trial 2. Type of Judgment/Order Appealed 9 Default judgment 9 Dismissal/FRCP 12(b)(1) lack of subject matter juris. 9 Dismissal/FRCP 12(b)(6) failure to state a claim 9 Dismissal/28 U.S.C. § 1915(e)(2) frivolous complaint 9 Dismissal/28 U.S.C. § 1915(e)(2) other dismissal 9 9 9 9 9 9 9 9 9 (Check as many as apply) 3. Relief 9 Damages: Sought: $ Granted: $ Denied: $ 9 Injunctions: 9 Preliminary 9 Permanent 9 Denied Dismissal/other jurisdiction Dismissal/merit Judgment / Decision of the Court Summary judgment Declaratory judgment Jury verdict Judgment NOV Directed verdict Other (specify): PART C: NATURE OF SUIT (Check as many as apply) 1. Federal Statutes 9 Antitrust 9 Bankruptcy 9 Banks/Banking 9 Civil Rights 9 Commerce 9 Energy 9 Commodities 9 Other (specify): 9 9 9 9 9 9 9 Communications Consumer Protection Copyright 9 Patent Trademark Election Soc. Security Environmental 9 9 9 9 9 9 Freedom of Information Act Immigration Labor OSHA Securities Tax 2. Torts 9 Admiralty/ Maritime 9 Assault / Defamation 9 FELA 9 Products Liability 9 Other (Specify): 3. Contracts 9 Admiralty/ Maritime 9 Arbitration 9 Commercial 9 Employment 9 Insurance 9 Negotiable Instruments 9 Other Specify 4. Prisoner Petitions 9 9 9 9 9 9 Civil Rights Habeas Corpus Mandamus Parole Vacate Sentence Other 5. Other 9 Hague Int'l Child Custody Conv. 9 Forfeiture/Penalty 9 Real Property 9 Treaty (specify): 9 Other (specify): 6. General 9 Arbitration 9 Attorney Disqualification 9 Class Action 9 Counsel Fees 9 Shareholder Derivative 9 Transfer 7. Will appeal raise constitutional issue(s)? 9 Yes 9 No Will appeal raise a matter of first impression? 9 Yes 9 No 1. Is any matter relative to this appeal still pending below? 9 Yes, specify: 9 No 2. To your knowledge, is there any case presently pending or about to be brought before this Court or another court or administrative agency which: (A) Arises from substantially the same case or controversy as this appeal? 9 Yes 9 No (B) Involves an issue that is substantially similar or related to an issue in this appeal? 9 Yes 9 No If yes, state whether 9 "A," or 9 "B," or 9 both are applicable, and provide in the spaces below the following information on the other action(s): Case Name: Docket No. Citation: Court or Agency: Name of Appellant: Date: Signature of Counsel of Record: NOTICE TO COUNSEL Once you have filed your Notice of Appeal with the District Court or the Tax Court, you have only 14 days in which to complete the following important steps: 1. Complete this Civil Appeal Pre-Argument Statement (Form C); serve it upon all parties, and file it with the Clerk of the Second Circuit in accordance with LR 25.1. 2. File the Court of Appeals Transcript Information/Civil Appeal Form (Form D) with the Clerk of the Second Circuit in accordance with LR 25.1. 3. Pay the$505 docketing fee to the United States District Court or the $500 docketing fee to the United States Tax Court unless you are authorized to prosecute the appeal without payment. PLEASE NOTE: IF YOU DO NOT COMPLY WITH THESE REQUIREMENTS WITHIN 14 DAYS, YOUR APPEAL WILL BE DISMISSED. SEE LOCAL RULE 12.1. FORM C (Rev. December 2016) American LegalNet, Inc. www.FormsWorkFlow.com