UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT CIVIL APPEAL INFORMATION STATEMENT COUNSEL FOR APPELLANT: This statement is due to be filed with the Clerk of the Court of Appeals not later than 14 days from the docketing of the notice of appeal. SHORT CAPTION WITH IDENTITY OF APPELLANT: ___________________________________________________________________________________ APPEAL FROM DISTRICT COURT: District:____________________________________________________________________________ D.C. Docket No.:_____________________________________________________________________ Date proceedings initiated in D.C.:_______________________________________________________ Date Notice of Appeal filed:____________________________________________________________ USCA No.:_________________________________________________________________________ ___________________________________________________________________________________ COUNSEL ON APPEAL Appellant(s):_______________________________________________________________________ Name of Counsel:____________________________________________________________________ Name of Party(ies):___________________________________________________________________ Address:___________________________________________________________________________ Telephone No.:______________________________________________________________________ Fax No.:____________________________________________________________________________ E-mail:_____________________________________________________________________________ For Appellee(s): *List only the names of parties and counsel who will oppose you on appeal Name of Counsel:____________________________________________________________________ Name of Party(ies):___________________________________________________________________ Address:___________________________________________________________________________ Telephone No.:______________________________________________________________________ Fax No.:____________________________________________________________________________ E-mail:_____________________________________________________________________________ Name of Counsel:____________________________________________________________________ Name of Party(ies):___________________________________________________________________ Address:___________________________________________________________________________ Telephone No.:______________________________________________________________________ Fax No.:____________________________________________________________________________ E-mail:_____________________________________________________________________________ No Is this a Cross-Appeal? Yes Appeals Docket No.:__________________________________________________________________ Was there a previous appeal in case? Yes No If yes, Short Title:____________________________________________________________________ Appeals Docket No.:__________________________________________________________________ Citation, if reported:__________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com To your knowledge is there any case now pending or about to be brought before this Court or any other court or administrative agency which: a) Arises from substantially the same case or controversy as this appeal? Yes No b) Involves an issue that is substantially the same, similar, or related to an issue in this appeal? Yes No If you answered yes to either "a" or "b" please provide: Case Name:_________________________________________________________________________ D.C. Docket No.:_____________________________________________________________________ Court or Agency:_____________________________________________________________________ Docket Number:_____________________________________________________________________ Citation, if reported:__________________________________________________________________ ___________________________________________________________________________________ NATURE OF SUIT (Check as many as apply) 1. FEDERAL STATUTES ANTITRUST BANKRUPTCY BANKS & BANKING CIVIL RIGHTS COMMERCE, ROUTES, AND TARIFFS COMMODITIES COMMUNICATIONS CONSUMER PROTECTION COPYRIGHT PATENT TRADEMARK ELECTION ENERGY ENVIRONMENTAL FOIA FREEDOM OF INFORMATION IMMIGRATION LABOR OSHA SECURITIES SOCIAL SECURITY TAX EQUAL ACCESS TO JUSTICE OTHER Specify:______________________ 2. TORTS ADMIRALTY ASSAULT/DEFAMATION PRODUCT LIABILITY/WARRANTY DIVERSITY OTHER Specify:______________________ 3. CONTRACTS ADMIRALTY/MARITIME ARBITRATION COMMERCIAL EMPLOYMENT INSURANCE NEGOTIABLE DISBURSEMENTS OTHER Specify:______________________ 4. PRISONER PETITIONS CIVIL RIGHTS VACATE SENTENCE 2255 HABEAS CORPUS 2254 HABEAS CORPUS 2241 MANDAMUS/PROHIBITION OTHER Specify:______________________ 5. OTHER FORFEITURE CIVIL GRAND JURY TREATY Specify:_____________________ OTHER Specify:______________________ This is to certify that this civil appeal information statement was filed with the Clerk of the U.S. Court of Appeals for the Third Circuit and a copy hereof served to each party or their counsel of record this _____ day of ____________________, 20_____ . Signature of Counsel:_________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com