UNITED STATES COURT OF APPEALS DISTRICT OF COLUMBIA CIRCUIT 333 Constitution Avenue, NW Washington, DC 20001-2866 Phone: 202-216-7000 | Facsimile: 202-219-8530 CIVIL DOCKETING STATEMENT All Cases Other than Administrative Agency Cases (To be completed by appellant) 1. CASE NO. 3. CASE NAME (lead parties only) 4. TYPE OF CASE: 2. DATE DOCKETED: v. District Ct Criminal Bankruptcy US Civil Private Civil Original proceeding Bankruptcy - if direct from Bankruptcy Court 5. IS THIS CASE REQUIRED BY STATUTE TO BE EXPEDITED? No Yes If YES, cite statute 6. CASE INFORMATION: Bankruptcy Court Docket No. a. District Court Docket No. Tax Court Docket No. Civil Action Bankruptcy Tax Adversary Criminal Ancillary Miscellaneous b. Review is sought of: Final Order Interlocutory Order appealable as of right Interlocutory Order certified for appeal c. Name of judge who entered order being appealed: Judge Magistrate Judge d. Date of order(s) appealed (use date docked): f. Has any other notice of appeal been filed in this case? g. Are any motions currently pending in trial court? Yes If YES, identify motion h. Has a transcript of proceedings been ordered pursuant to FRAP 10(b)? If NO, why not? Yes No Yes No e. Date notice of appeal filed: No If YES, date filed: If YES, date filed: i. Has this case been before the Court under another appeal number? Yes Appeal # No j. Are any cases involving the same underlying order or, to counsel's knowledge, involving substantially the same issue, currently pending before the District Court, this Court, another Circuit Court, or the Supreme Court? Yes No If YES, give each case's court and case name, and docket number: k. Does this case turn on validity or correct interpretation or application of a statute? No Yes If YES, program name and participation dates 7. Have the parties attempted to resolve issues in this case through arbitration, mediation, or another alternative for dispute resolution? Yes No If so, provide program name and participation dates Signature Name of Party Name of Counsel for Appellant/Petitioner Address Phone ( ) Fax ( ) Date ATTACH A CERTIFICATE OF SERVICE Note: If counsel for any other party believes that the information submitted is inaccurate or incomplete, counsel may so advise the Clerk within 7 calendar days by letter, with copies to all other parties, specifically referring to the challenged statement. Attach a certificate of service to this form. USAC Form 42 August 2009 (REVISED) American LegalNet, Inc. www.FormsWorkFlow.com