A-11 (rev. 7/00) Page 1 of 2 USCA DOCKET # (IF KNOWN) UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CIVIL APPEALS DOCKETING STATEMENT PLEASE ATTACH ADDITIONAL PAGES IF NECESSARY. TITLE IN FULL: DISTRICT: JUDGE: DISTRICT COURT NUMBER: DATE NOTICE OF APPEAL FILED: IS THIS A CROSS APPEAL? YES IF THIS MATTER HAS BEEN BEFORE THIS COURT PREVIOUSLY, PLEASE PROVIDE THE DOCKET NUMBER AND CITATION (IF ANY): BRIEF DESCRIPTION OF NATURE OF ACTION AND RESULT BELOW: PRINCIPAL ISSUES PROPOSED TO BE RAISED ON APPEAL: PLEASE IDENTIFY ANY OTHER LEGAL PROCEEDING THAT MAY HAVE A BEARING ON THIS CASE (INCLUDE PENDING DISTRICT COURT POST-JUDGMENT MOTIONS): DOES THIS APPEAL INVOLVE ANY OF THE FOLLOWING: Possibility of Settlement Likelihood that intervening precedent will control outcome of appeal Likelihood of a motion to expedite or to stay the appeal, or other procedural matters (Specify) Any other information relevant to the inclusion of this case in the Mediation Program Possibility parties would stipulate to binding award by Appellate Commissioner in lieu of submission to judges American LegalNet, Inc. www.FormsWorkflow.com Page 2 of 2 LOWER COURT INFORMATION JURISDICTION DISTRICT COURT DISPOSITION FEDERAL APPELLATE FEDERAL QUESTION FINAL DECISION OF DISTRICT COURT DIVERSITY INTERLOCUTORY DECISION APPEALABLE AS OF RIGHT OTHER (SPECIFY): TYPE OF JUDGMENT/ORDER APPEALED INTERLOCUTORY ORDER CERTIFIED BY DISTRICT JUDGE (SPECIFY): DEFAULT JUDGMENT DISMISSAL/JURISDICTION DISMISSAL/MERITS SUMMARY JUDGMENT JUDGMENT/COURT DECISION JUDGMENT/JURY VERDICT DECLARATORY JUDGMENT JUDGMENT AS A MATTER OF LAW OTHER (SPECIFY): RELIEF DAMAGES: SOUGHT $ AWARDED $ INJUNCTIONS: PRELIMINARY PERMANENT GRANTED DENIED ATTORNEY FEES: SOUGHT $ AWARDED $ PENDING OTHER (SPECIFY): COSTS: $ CERTIFICATION OF COUNSEL I CERTIFY THAT: 1. COPIES OF ORDER/JUDGMENT APPEALED FROM ARE ATTACHED. 2. A CURRENT SERVICE LIST OR REPRESENTATION STATEMENT WITH TELEPHONE AND FAX NUMBERS IS ATTACHED (SEE 9TH CIR. RULE 3-2). 3. A COPY OF THIS CIVIL APPEALS DOCKETING STATEMENT WAS SERVED IN COMPLIANCE WITH FRAP 25. 4. I UNDERSTAND THAT FAILURE TO COMPLY WITH THESE FILING REQUIREMENTS MAY RESULT IN SANCTIONS, INCLUDING DISMISSAL OF THIS APPEAL. Signature Date COUNSEL WHO COMPLETED THIS FORM NAME FIRM ADDRESS CITY STATE E-MAIL ZIP CODE TELEPHONE FAX **THIS DOCUMENT SHOULD BE FILED IN DISTRICT COURT WITH THE NOTICE OF APPEAL. ** **IF FILED LATE, IT SHOULD BE FILED DIRECTLY WITH THE U.S. COURT OF APPEALS.** American LegalNet, Inc. www.FormsWorkflow.com