Appellate Docket Number: ___________________________________________ Appellate Case Style: ________________________________________________ DOCKETING STATEMENT (CIVIL) Tenth Court of Appeals McLennan County Courthouse 501 Washington Ave., Rm 415 Waco, Texas 76701-1373 (254) 757-5200 [to be filed in the court of appeals upon perfection of appeal under TRAP 32] I. Parties (TRAP 32.1(a), (e)): Appellant(s): Appellee(s): (See note at bottom of page) (See note at bottom of page) Attorney (lead appellate counsel): Attorney (lead appellate counsel, if known; if not, then trial counsel): Address (lead counsel): Address (lead appellate counsel, if known; if not, then trial counsel): Telephone Number: (include area code) Fax Number: (include area code) Email: Telephone Number: (include area code) Fax Number: (include area code) Email: SBN (lead counsel): SBN (lead counsel): If not represented by counsel, provide appellant’s/appellee’s address, telephone number, and fax number. On Attachment 1, or a separate attachment if needed, list the same information stated above for any additional parties to the trial court’s judgment. -1American LegalNet, Inc. www.FormsWorkFlow.com II. Perfection Of Appeal And Jurisdiction (TRAP 32.1(b), (c), (g), (j)): Date order or judgment signed: Date notice of appeal filed in trial court: (Attach a copy showing signature, if possible) What type of judgment? (e.g., jury trial, bench trial, summary judgment, directed verdict, other (specify)) (Attach file-stamped copy; if mailed to the trial court clerk, also give the date of mailing) Interlocutory appeal of appealable order: Yes □ No □ (Please specify statutory or other basis on which interlocutory order is appealable) (See TRAP 28) If money judgment, what was the amount? Actual damages: Accelerated appeal (See TRAP 28): Yes □ No □ Punitive (or similar) damages: (Please specify statutory or other basis on which appeal is accelerated) Attorneys’ fees (trial): Attorneys’ fees (appellate): Appeal that receives precedence, preference, or priority under statute or rule? Other (specify): Yes □ No □ (Please specify statutory or other basis for such status) -2American LegalNet, Inc. www.FormsWorkFlow.com Appeal from final judgment? Yes □ No □ Will you challenge this Court’s jurisdiction? If yes, explain. Does judgment dispose of all parties and issues: Yes □ No □ Does judgment have a Mother Hubbard clause? (E.g.: “All relief not expressly granted is denied”): Yes □ No □ Does judgment have language that one or more parties “take nothing”? Yes □ No □ Other basis for finality? III. Actions Extending Time To Perfect Appeal (TRAP 32.1(d)): Filed Action Check as appropriate Motion for New Trial No □ Yes □ Motion to Modify Judgment No Request for Findings of Fact and Conclusions of Law Motion to Reinstate No Motion under TRCP 306a No Other (specify): No No □ □ □ □ □ Yes Yes Yes Yes Yes Date Filed □ □ □ □ □ IV. Indigency Of Party (TRAP 32.1(k)): (Attach file-stamped copy of affidavit) Filed Event Check as appropriate Date Affidavit filed No □ Yes □ Contest filed No □ Yes N/A □ Date ruling on contest due: Ruling on contest: Sustained Overruled V. Bankruptcy (TRAP 8): Will the appeal be stayed by bankruptcy? Date bankruptcy filed? Name of bankruptcy court: Bankruptcy Case No.: Style of bankruptcy case: -3American LegalNet, Inc. www.FormsWorkFlow.com VI. Court: Trial Court And Record (TRAP 32.1(c), (h), (i)): County: Trial Court Docket Number (Cause No.): Trial Judge (who tried or disposed of case): District/County Clerk: Telephone Number: (include area code) Telephone Number: (include area code) Fax Number: (include area code) Fax Number: (include area code) Address: Address: Clerk’s Record Yes Sworn copy for accelerated appeal □ Yes Will request □ (Note: No request required under TRAP 34.5(a), (b)) □ Clerk’s fee has been paid or satisfactory arrangements have been made: Yes □ No □ (See TRAP 28.3) Was requested on: If no, explain: All court reporters/records who recorded any portion of the record must be listed: Court Reporter/ Recorder: Court Reporter/Recorder: Telephone Number: (include area code) Telephone Number: (include area code) Fax Number: (include area code) Fax Number: (include area code) Address: Address: (Attach additional sheet if necessary for additional court reporters/recorders) Length of trial (approximate): Reporter’s fee has been paid or satisfactory arrangements have been made: Yes □ No □ If no, explain: Reporter’s or Recorder’s Record (check if electronic recording None □ Will request □ Was requested on: □) -4American LegalNet, Inc. www.FormsWorkFlow.com VII. Nature Of The Case (TRAP 32.1(f)) (Subject matter or type of case: E.g., personal injury, breach of contract, workers’ compensation, or temporary injunction) (see list below): Administrative/agency _____ Malpractice Legal _____ Medical _____ Other _____ Banking _____ Business _____ Motor Vehicle _____ Condemnation _____ Municipal _____ Consumer/DTPA _____ Oil & Gas _____ Construction _____ Personal Injury _____ Contract _____ Premises Liability _____ Employment/Labor _____ Probate _____ Family _____ Products Liability _____ Custody _____ Real Property _____ Property Division _____ Securities _____ Termination _____ Tax _____ Other _____ U.C.C./Tex. Bus. & Com. Code _____ Fraud _____ Venue _____ Insurance _____ Workers’ compensation _____ Juvenile _____ Other (specify): _____ Landlord/Tenant _____ VIII. Supersedeas Bond (TRAP 32.1(1)): IX. None □ Will file □ Was filed on: Extraordinary Relief: Will you request extraordinary relief (e.g., temporary or ancillary relief) from this Court? Yes □ No □ If yes, briefly state the basis for your request. -5American LegalNet, Inc. www.FormsWorkFlow.com X. Alternative Dispute Resolution/Mediation (if applicable) (The Tenth Court of Appeals participates in the ADR process on cases determined to be appropriate for mediation. To assist the Court in making that determination, the Court request the parties provide the following information)). (Use additional sheets, if necessary) 1. Should this appeal be referred to mediation? If not, why not. 2. Has the case been through an ADR procedure in the trial court? If yes, answer the following: a. Who was the mediator? b. What type of ADR procedure? c. At what stage did the case go through ADR? (Specify pre-trial, trial, post-trial, other) d. Rate the case for complexity. Use 1 for the least complex and 5 for the most complex. Circle one. 1 2 3 4 5 e. Can the parties agree on an appellate mediator? If yes, give name, address, and telephone and fax numbers (with area codes). f. Languages other than English in which the mediator should be proficient: 3. Give a brief description of the issues to be raised on appeal, the relief sought, and the applicable standard of review, if known (without prejudice to the right to raise additional issues or request additional relief; use a separate attachment, if necessary). -6American LegalNet, Inc. www.FormsWorkFlow.com XI. Related Matters: List any pending or past related appeals or original proceedings (e.g., mandamus, injunction, habeas corpus) before this or any other Texas appellate court by court, docket number, and style. XII. Other Information: Please give any other information helpful to process this appeal (see attachments, if any). XIII. Signature: __________________________________________________ Date: _________________________ Signature of counsel (or pro se party) State Bar No.:___________________ Printed Name: _____________________________________ XIV. Certificate of Service: The undersigned counsel certifies that this docketing statement has been served on the following lead counsel for all parties to the trial court’s order or judgment as follows on ______________________, 20____. ________________________________________ Signature (TRAP 9.5(e) requirements stated below; use additional sheets, if necessary) Note: Certificate of Service Requirements (TRAP 9.5(e)): A certificate of service must be signed by the person who made the service and must state: (1) (2) (3) the date and manner of service; the name and address of each person served; and if the person served is a party’s attorney, the name of the party represented by that attorney. -7American LegalNet, Inc. www.FormsWorkFlow.com