IN THE _________________________ COURT _______________COUNTY, OHIO ___________________________ Plaintiff v. ___________________________ Defendant Trial Ct. Case No. __________________ Appellate Case No. _________________ STATEMENT AND PRAECIPE (Statement of the Evidence) TO THE APPELLEE(S): The appellant hereby states that a statement of the evidence or proceedings (Appellate Rule 9(C) will be submitted to be included as part of the record on appeal). TO THE CLERK: Immediately prepare and assemble the original papers and exhibits thereto filed in the trial court and a certified copy of the docket and journal entries. As a statement of the evidence or proceedings (as above) will be included by the appellant(s) of error, do not transmit these documents to the clerk of the Court of Appeals of this county for file in case number in that court until the statement of the evidence or proceedings (as above) has been delivered to you by the undersigned. At that time you will transmit the documents prepared and assembled by you and the statement of the evidence or proceedings delivered to you by the undersigned to the clerk of the Court of Appeals for file as the record on appeal. In the event that the undersigned does not furnish you with the statement of the evidence or proceedings (as above) within forty days after the filing of the notice of appeal, or within the time for filing the record set forth in the accelerated calendar scheduling order, or within a proper extension thereof, as prescribed by the Appellate Rules or by the Local Appellate Rules, then upon such fortieth day, or pursuant to scheduling order, or upon the last day of any proper extension of the time for transmission of the record, you shall transmit the documents prepared and assembled by you to the clerk of the Court of Appeals without such statement of the evidence or American LegalNet, Inc. www.FormsWorkFlow.com proceedings, for file as the record on appeal. __________________________________ __________________________________ __________________________________ __________________________________ CERTIFICATE OF SERVICE I hereby certify that a copy of this Statement and Praecipe was served by regular mail upon ______________________________________________________________________________ ___________________________________________________ this ____ day of ____________, 20__. __________________________________ American LegalNet, Inc. www.FormsWorkFlow.com