R evised 4-3-09vb DOCKETING STATEMENT FOR A CIVIL APPEAL This docketing statement must be filed by all appellants with the Clerk of the Fourth Court of Appeals, 300 Dolorosa, Suite 3200, San Antonio, TX 78205, upon perfecting appeal. See TEX . R. APP . P. 32.1. Appeal No. _________________________________________ (To be assigned by the Clerk of the Fourth Court of Appeals.) Case Style Below _______________________________________________________________________________ v. _______________________________________________________________________________ Trial Court No. _______________________ Court No. & County __________________________________________ APPELLANT(S) Name of appellant(s)*_______________________________________________________________________________ Name of lead counsel (if represented)___________________________________________________________________ Law firm (if attorney)________________________________________________________________________________ Address___________________________________________________________________________________________ Phone ( )________________________ FAX ( )_____________________ SBN ______________________________ Posture in trial court (plaintiff/defendant/third-party, etc.)___________________________________________________ Are any related cases or cases raising related issues pending in this court or the trial court, i.e., co-defendant or same issue involving another defendant? Q YES Q NO If yes, cite the case and the manner in which it is related on a separate page. If abeyance, consolidation, or joint oral argument is warranted, counsel must file a separate motion seeking such relief. NOTICE OF APPEAL AND CLERK’S RECORD Date filed in the trial court_________________Date mailed to the trial court clerk, if applicable_____________________ Date clerk’s record requested ________________________________ TRIAL COURT Name of judge who tried the case and signed the judgment or appealable order___________________________________ Proceeding appealed: Q JURY TRIAL Q BENCH TRIAL Q SUMMARY JUDGMENT Q DIRECTED VERDICT Q DISMISSAL ORDER Q DEFAULT JUDGMENT Q JNOV Q INTERLOCUTORY (explain)___________________________________ Q OTHER (explain)_____________________________________________________________________ Date judgment or appealable order signed_______________________ (Attach copy of judgment or appealable order.) Filing date of MNT, Motion to Modify, Request for FF/CL, Motion to Reinstate, or other filing that affects time for perfecting appeal___________________________________________________________________________________ OTHER PARTIES Provide the following information as to every other party to the judgment/appealable order: Party names(s)*____________________________________________________________________________________ Lead counsel (if represented)__________________________________________________________________________ Law Firm_________________________________________________________________________________________ Address__________________________________________________________________________________________ Phone ( )______________________ FAX ( )_______________________ SBN______________________________ Posture in trial court________________________________________________________________________________ *For multiple parties, use additional paper as necessary. American LegalNet, Inc. www.FormsWorkflow.com Or check Q if appellant diligently inquired but could not discover the information. GENERAL NATURE OF THE CASE Cause(s) of action: __________________________________________________________________________________ Relief sought below: ________________________________________________________________________________ Amount of judgment: _______________________________________________________________________________ TYPE OF APPEAL Q REGULAR Q RESTRICTED Q ORIGINAL PROCEEDING Under what authority would this case be given priority or accelerated? _________________________________________ Under what statute is appellate jurisdiction invoked? _______________________________________________________ REPORTER’S RECORD Date requested: ______________________________________ Electronically recorded? Q YES Q NO Dates of trial or hearing(s): ______________________________________ Was a court reporter present? Q YES Q NO Will there be an agreed record or an agreed statement of the case? Q YES Q NO Court reporter’s name: _______________________________________________________________________________ a. Q OFFICIAL or Q SUBSTITUTE b. Address and phone no.: __________________________________________________________________ c. If substitute, name of official court reporter for trial court: ______________________________________ TEMPORARY RELIEF Is temporary relief sought during the course of the appeal? Q YES Q NO Type of relief: _____________________________________________________________________________________ PAYMENT OR AFFIDAVIT OF INDIGENCE If not indigent, have payment arrangements been made for record? Q YES Q NO Date filed: _________________________________ Date contest filed, if any: __________________________________ Date of order on contest, if any: ___________________ Ruling: Q SUSTAINED Q OVERRULED Q NO RULING SUPERSEDEAS BOND Date filed, if any: _______________________________ Amount: ___________________________________________ BANKRUPTCY If any party to the court’s judgment filed for protection in bankruptcy which might affect this appeal, attach a copy of the petition. ALTERNATIVE DISPUTE RESOLUTION If this appeal should be referred to a settlement procedure, complete and file a separate ADR form. CERTIFICATE OF SERVICE As attorney of record (or appellant pro se), I hereby certify that a copy of this docket sheet has been served by first class mail or by fax, prior to filing, to all other parties to the judgment or order being appealed. Date __________________ Attorney of Record (signature) _______________________________________________ American LegalNet, Inc. www.FormsWorkflow.com