ELEVENTH DISTRICT COURT OF APPEALS DOCKETING STATEMENT (To be attached to and filed with Notice of Appeal) Name of Trial Court Plaintiff-Appell - vs - Trial Court No. Court of Appeals No. Defendant-Appell REGULAR CALENDAR Case should be assigned to the Regular Calendar with full briefing. ACCELERATED CALENDAR - (Check if this applies) I have read Loc.R.11.1. This appeal meets those requirements, and I request that it be briefed and decided on the Accelerated Calendar. EXPEDITED APPEAL This case should be heard as an expedited appeal as defined under App.R. 11.2 because: (State provision of App.R. 11.2 or applicable statute): ORAL ARGUMENT To expedite oral argument, I am willing to travel to whichever adjoining county in which the Eleventh District has the first available date. I want oral argument in this appeal set in the county in which the appeal originates. CASE TYPE A. Criminal Specify nature of offense(s) (e.g., assault, burglary, rape:) (1) Is the defendant presently in jail? No If the answer is "Yes," give date of incarceration Yes When is he/she due to be released (if you know)? (2) Has a stay been filed in the trial court? Yes No If granted, what are the terms? (3) Does the judgment entry comply with Crim.R. 32(C) by including the plea, verdict or findings, and a sentence? Yes No If the answer is "No," this is not a final appealable order. Date of Conviction: B. Post-Conviction Relief C. Civil Specify cause(s) of action: App.R. 11.2 (Abortion, Adoption, or Termination of Parental Rights Appeal). American LegalNet, Inc. www.FormsWorkFlow.com PROBABLE ISSUE FOR REVIEW THE FOLLOWING QUESTIONS APPLY TO ALL CIVIL AND ADMINISTRATIVE APPEALS 1. FINAL APPEALABLE ORDER (a) Has the trial court disposed of all claims by and against all parties? Yes (Attach copies of all judgments and orders indicating that all claims against all parties have been concluded.) No (b) If the answer to (a) is "No," has the trial court made an express determination that there is "no just reason for delay," pursuant to Civ.R. 54(B), with respect to the judgment or order from which the appeal is taken? Yes (Attach a copy of that order.) No (c) Is the judgment order subject to immediate appeal under R.C. 2505.02? If so, set forth the specific provision(s) that authorize this appeal: (d) Does the right to an immediate appeal arise from a provision of a statute other than R.C. 2505.02? If so, identify that statute: 2. MEDIATION (a) Would a pre-hearing conference or mediation assist in the resolution of this matter? Yes Please explain (optional) No Maybe CERTIFICATE OF SERVICE: I certify that I have mailed or otherwise delivered a copy of this Docketing Statement to all counsel of record, or to the parties if unrepresented. The following is a listing of the name, address and telephone number of all counsel and the parties they represent and any parties not represented by counsel: (attach extra sheet if necessary) DATE Admin/Forms/New Dkt Stmt. 4 Revised 04/26/2011 SIGNATURE _____________________________________ American LegalNet, Inc. www.FormsWorkFlow.com