UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT DOCKETING STATEMENT Administrative Agency Review/Enforcement Proceedings 1. DOCKET NO.: 3. CASE NAME (Lead Parties Only) Petitioner v. Respondent 4. TYPE OF CASE: 5. CASE INFORMATION: a. b. c. d. e. Identify agency whose order is to be reviewed: Give agency docket or docket number(s): Give date(s) of order(s): Is a request for rehearing or reconsideration pending at the agency? Yes No Review Enforcement 2. DATE DOCKETED: Are any other cases involving the same underlying agency order pending in this Court or in any other court? Yes No If Yes, identify name(s), docket number(s), and court(s): f. Are any other cases, to counsel's knowledge, pending before the agency, this Court or the Supreme Court which involve substantially the same issues as the instant case presents? Yes No If Yes, give name(s) of these cases and identify court/agency: Signature: Name of Counsel or Pro Se Litigant (Print) Firm: Address: Name of Party Represented: ATTACH A CERTIFICATE OF SERVICE Phone: Date: Note: If counsel for any other party believes that the information submitted is inaccurate or incomplete, counsel may so advise the Clerk within 10 days by letter specifically referring to the challenged statement. Rev. 10/1/2013 American LegalNet, Inc. www.FormsWorkFlow.com