Appellate Docket Number: ___________________________________________ Appellate Case Style: ***For Civil Appeals, see Section X for information about the Pro Bono Program sponsored and administered by the Pro Bono Committees of the Appellate Practice Sections of the State Bar of Texas and the Houston Bar Association. DOCKETING STATEMENT (CIVIL) Fourteenth Court of Appeals [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): Email address: Email address: Telephone: (include area code) Telephone: (include area code) Telecopy: (include area code) Telecopy: (include area code) SBN (lead counsel): SBN (lead counsel): If not represented by counsel, provide appellant’s/appellee’s address, email address, telephone number, and telecopy 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. American LegalNet, Inc. www.FormsWorkFlow.com II. Perfection Of Appeal And Jurisdiction (TRAP 32.1(b), (c), (g), (j)): Date order or judgment signed: (Attach a signed copy, if possible) Date notice of appeal filed in trial court: (Attach file-stamped copy; if mailed to the trial court clerk, also give the date of mailing) What type of judgment? (e.g., jury trial, bench trial, summary judgment, directed verdict, other (specify)) 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  Punitive (or similar) damages: No  (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? Yes  No  (Please specify statutory or other basis for such status) Other (specify): III. Actions Extending Time To Perfect Appeal (TRAP 32.1(d)): Action Filed Check as appropriate Motion for New Trial No  Yes  Motion to Modify Judgment No  Yes  Request for Findings of Fact and Conclusions of Law No  Date Filed Yes  American LegalNet, Inc. www.FormsWorkFlow.com Motion to Reinstate No  Yes  Motion under TRCP 306a No  Yes  Other (specify): No  Yes  IV. Indigency Of Party (TRAP 32.1(k)): (Attach file-stamped copy of affidavit) Filed Check as appropriate Event Affidavit filed No  No  N/A Yes  Contest filed Date Yes  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: VI. Trial Court And Record (TRAP 32.1(c), (h), (i)): Court: County: Trial Court Docket Number (Cause No.): Trial Judge (who tried or disposed of case): Court Clerk (district clerk): Telephone Number: (include area code) Telephone Number: (include area code) : : American LegalNet, Inc. www.FormsWorkFlow.com Address: Address: Clerk’s Record Yes Sworn copy for accelerated appeal  Will request  (Note: No request required under TRAP 34.5(a), (b)) Was requested on: Yes  (See TRAP 28.3) Court Reporter or Court Recorder: Court Reporter or Court Recorder: Telephone Number: (include area code) Telephone Number: (include area code) Telecopy Number: (include area code) Telecopy Number: (include area code) Address: Address: (Attach additional sheet if necessary for additional court reporters/recorders) Length of trial (approximate): Reporter’s or Recorder’s Record (check if electronic recording ) VII. State arrangements made for payment of court reporter/recorder: None  Will request  Was requested on: Nature Of The Case (TRAP 32.1(f)) (Subject matter or type of case: E.g., personal injury, breach of contract, workers’ compensation, condemnation, DTPA, employment/labor, family code, juvenile, malpractice, probate, UCC, tax, oil & gas, real property or temporary injunction): American LegalNet, Inc. www.FormsWorkFlow.com 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? If yes, briefly state the basis for your request. X. Yes  No  Pro Bono Program: The Pro Bono Committees of the Appellate Practice Sections of the State Bar of Texas and the Houston Bar Association are participating in a Pro Bono Program to place a limited number of civil appeals with appellate counsel who will represent the appellant/appellee in the appeal before the Fourteenth Court. The Pro Bono Committee is solely responsible for screening and selecting the civil cases for inclusion in the Program based upon a number of discretionary criteria, including the financial means of the appellant. If a case is selected by the Committee, and can be matched with appellate counsel, that counsel will take over representation of the appellant without charging legal fees. More information regarding this program can be found in the Pro Bono Program Pamphlet available at the State Bar of Texas Appellate Pro Bono website, http://www.tex-app.org/probono.php, and the Houston Bar Association Appellate Section website, http://www.hba.org/folder-sections/sec-appellate.htm. If your case is selected and matched with a volunteer lawyer, you will receive a letter from the Pro Bono Committee within thirty (30) to forty-five (45) days after submitting this Docketing Statement. NOTE: There is no guarantee that, if you submit your case for possible inclusion in the Pro Bono Program, the Pro Bono Committee will select your case and that pro bono counsel can be found to represent you. Accordingly, you should not forego seeking other counsel to represent you in this proceeding. By signing your name below, you are authorizing the Pro Bono Committee to transmit publicly available facts and information about your case, including parties and background, through selected Internet sites and a Listserv to its pool of volunteer appellate attorneys. 1. Do you want this case to be considered for inclusion in the Pro Bono Program? Yes  No  If you answered “Yes” to Question X.1, then please answer the following questions. 2. Do you authorize the Pro Bono Committee to contact your trial counsel of record in this matter to answer questions the committee may have regarding the appeal? Please note that any such conversations would be maintained as confidential by the Pro Bono Committee and the information used solely for the purposes of considering the case for inclusion in the Pro Bono Program. Yes  No  American LegalNet, Inc. www.FormsWorkFlow.com 3. If you have not previously filed an affidavit of indigency and attached a file-stamped copy of that affidavit, does your income exceed 200% of the U.S. Department of Health and Human Services Federal Poverty Guidelines? These guidelines can be found in the Pro Bono Program Pamphlet as well as on the Internet at http://aspe.hhs.gov/poverty/06poverty.shtml. Yes  No  4. Are you willing to disclose your financial circumstances to the Pro Bono Committee? If so, please attach an Affidavit of Indigency completed and executed by the appellant. Sample forms are available at the State Bar of Texas Appellate Pro Bono website, http://www.tex-app.org/probono.php, and the Houston Bar Association Appellate Section website, http://www.hba.org/folder-sections/sec-appellate.htm. Your participation in the Pro Bono Program may be conditioned upon your execution of an affidavit under oath as to your financial circumstances. Yes  No  5. 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). XI. Alternative Dispute Resolution/Mediation (if applicable) (As of 8/19/97, these programs exist in the 1st (Houston), 3rd (Austin), 4th (San Antonio), 5th (Dallas), 9th (Beaumont), 13th (Corpus Christi), and 14th (Houston)). (Use additional sheets, if necessary). 1. Should this appeal be referred to mediation? Yes  No  If not, why not. 2. Has the case been through an ADR procedure in the trial court? Yes  If yes, answer the following: No  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. Check one. 1  2  3  4  5  American LegalNet, Inc. www.FormsWorkFlow.com e. Can the parties agree on an appellate mediator? If yes, give name, address, and telephone and telecopy numbers (with area codes). f. Languages other than English in which the mediator should be proficient: XII. 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. XIII. Any other information requested by the court (see attachments, if any). XIV. Signature: __________________________________________________ Date: _________________________ Signature of counsel (or pro se party) State Bar No.:___________________ Printed Name: _____________________________________ XV. 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. American LegalNet, Inc. www.FormsWorkFlow.com