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 CRIMINAL DOCKETING STATEMENT (To be completed by appellant) 1. Appellate Case Number: 1a. Criminal Action Number: 2. Case Name: 3. Appellant's Name: 3a. Appellant's Defendant No.: 3b. Appellant's Fed. Reg/PDID No. 4. Date of conviction 4a. Date of sentence 5. Name of District Court Judge 6. Date of Notice of Appeal Filed: 7. Offense(s) of conviction: Yes No 8. Did appellant plead guilty? 9. What sentence was imposed? 10. How much of the sentence has appellant served? 11. Is appellant challenging the conviction? Yes No 12. Is appellant challenging the sentence? No Yes 13. Has appellant filed a post-conviction motion? No Yes If yes, what motion, date filed, and disposition: 14. Is appellant incarcerated? No Yes If yes, where: Phone ( If no, address: 15. Has appellant moved for release pending appeal in District Court? Yes If yes, date filed Disposition: Yes If no, does defendant intend to file such a motion in the District Court? Yes 16. Will appellant file a motion for release pending appeal in court of appeals? Yes 17. Did appellant have court-appointed counsel in District Court? Yes 18. Does counsel appointed in District Court wish to continue on appeal? 19. Did defendant have retained counsel in district court? Yes Yes If yes, will case proceed on appeal with retained counsel? If no, will appellant seek appointment of counsel on appeal? Yes Yes If no, has a motion to proceed in forma pauperis been filed? 20. Has counsel ordered transcripts? Yes No 21. If yes, from what proceedings: 22. If yes, when will transcripts be completed? 23. Did counsel seek expedited preparation of sentencing transcripts? Yes Signature Name of Party Firm Address - No No No No No No No No No No Date Phone ( Note: ) ) - Fax ( ) - In all appeals of sentences of 8 months or less trial counsel is required to prosecute the appeal of the sentence. 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. USCA Form 43 August 2009 (REVISED) American LegalNet, Inc. www.FormsWorkFlow.com