Revised 7/3/17 DOCKETING STATEMENT FOR CRIMINAL APPEALS (Return form to the Appellate Court Clerk222s Office within 15 days) Case Style: Appeal No.: Appellant: County/Court: Trial Judge: Trial Court Number(s): Nature of Case (Original Appeal, Post-Conviction, Habeas Corpus, Probation Revocation, etc.): Offense Name(s) and TCA Section No(s): Sentence(s): Date of Offense(s): Date of Final Judgment/Final Order appealed from: Date of Denial of Motion for New Trial (or other applicable Post-Trial Motion): Date Transcript Ordered or Notice that no Transcript will be Filed: Is Appellant: Incarcerated/TOMIS #: On Appearance Bond (provide copy) Indigent? Yes No On Own Recognizance (provide proof) (If yes, provide proof) Appellant222s Address (include Facility name): Attorney222s Name and Address: Phone: () Phone: () Appointed Retained (Signature of Counsel or Pro Se Party) (Date) American LegalNet, Inc. www.FormsWorkFlow.com