First District Court of Appeals Form II Rev. 5/01 Civil Docket Statement (Must Be Typed and Filed In Duplicate and Served On Opposing Counsel) 2. Appeal No. 3. Trial No. 4. Trial Judge 5. Related Appeals 6. Date of Judgment/ Order Appealed From 7. Date Appeal Filed 1. Case Caption 8. Counsel for Appellant 9. Counsel for Appellee 10(A) Civil Rule 54-B If multiple judgments or claims: Does Civil Rule 54-B Apply: If yes, does the judgment include a certification of "No Just Cause for Delay?" Yes No Yes No 11. Record There will be a partial transcript of proceedings filed. Yes The parts to be ordered are: There will be a complete transcript of proceedings filed. Yes If either of the above are applicable the court reporter's certification below must be completed. If neither of the above are applicable then one of the following must be circled: There will be a statement filed pursuant to App. R. 9(C) Yes There will be an agreed statement filed pursuant to App. R. 9(D) Yes There is no transcript, statement or agreed statement to be filed. Yes Circling any of the above three will be deemed sufficient compliance with App. R. 9(C)and Local Rule 5. 12. Court Reporter's Certification The transcript as ordered consists of approximately pages and pursuant to Local Rule 10, the transcript will be prepared and ready for filing on Date: Signature: 13. Brief Upon the filing of the complete record I request ______ days to file the brief and assignments of error. 14. Nature of Appeal Please Check All That Apply and Provide Specific Information Whenever Space Is Provided. BE SURE TO NOTE IF THIS APPEAL IS PURSUANT TO APP R. 11.2 ADOPTION OR TERMINATION OF PARENTAL RIGHTS. ( ) APP R. 11.2 ADOPTION OR TERMINATION OF PARENTAL RIGHTS ( ) Adminstrative ( ) Attorney Fees ( ) Civil Service ( ) Constitutional Law ( ) Contracts ( ) Corporations/Partnerships ( ) Damages ( ) Declaratory Judgment Domestic Relations/Children ( ) Child Support ( ) Custody ( ) Dependency ( ) Divorce ( ) Other:__________________ ( ) ( ) ( ) ( ) ( ) ( ) Tort ( ) ( ) ( ) ( ) ( ) ( ) ( ) Insurance Landlord/Tenant Procedure/Rules Real Property Summary Judgment Tax Intentional Tort - Workplace Malpractice Negligence - Auto Negligence Product Liability Slip and Fall Other: Trial Matters ( ) Evidence ( ) Jury Instructions ( ) Expert Witnesses ( ) Other: ( ) Weight of Evidence ( ) Other: ( ( ( ( ( ( ) ) ) ) ) ) Unemployment Compensation Weight/Sufficiency of Evidence Workers Compensation Writs Zoning Other: 15. Probable Issues for Review 2002 © American LegalNet, Inc. 16. Case[s] and/or Statute[s] to be Discussed 17. Certificate of Service I certify that I have mailed or otherwise delivered a copy of this docket statement to all counsel of record or the parties if unrepresented. Date: Signature: 2002 © American LegalNet, Inc.