Page 1 of 11 Appellate Docket Number: Appellate Case Style: Vs. Companion Case(s): Amended/Corrected Statement DOCKETING STATEMENT (Civil) Appellate Court: (to be filed in the court of appeals upon perfection of appeal under TRAP 32) NOTE: Because space for additional parties / attorneys is limited on this form, you can include the information on a separate document. As per TRAP 32.1 and 9.4, please include party222s name and the name, address, email address, telephone number, fax number, if any, and State Bar Number of the party222s lead counsel. If the party is not represented by an attorney, that party222s name, address, telephone number, fax number should be provided. I. Appellant II. Appellant Attorney(s) - Continued Person Organization Name: Pro Se If Pro Se Party, enter the following information: Address: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: II. Appellant Attorney(s) Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 11 I II . Appell ee I V . Appell ee Attorney(s) - Continued Person Organization Name: Pro Se If Pro Se Party, enter the following information: Address: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: I V . Appell ee Attorney(s) Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Lead Attorney Name: Bar No. Firm/Agency: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 11 V. Perfection of Appeal, Judgment and Sentencing Nature of Case (Subject matter or type of case): Date Order or Judgment signed: Type of Judgment: Date Notice of Appeal filed in Trial Court: If mailed to the Trial Court clerk, also give the date mailed: Interlocutory appeal of appealable order: Yes No If yes, please specify statutory or other basis on which interlocutory order is appealable (See TRAP 28): Accelerated Appeal (See TRAP 28): Yes No If yes, please specify statutory or other basis on which appeal is accelerated: Parental Termination or Child Protection? (See TRAP 28.4): Yes No Permissive? (See TRAP 28.3): Yes No If yes, please specify statutory or other basis for such status: Agreed? (See TRAP 28.2): Yes No If yes, please specify statutory or other basis for such status: Appeal should receive precedence, preference, or priority under statute or rule? Yes No If yes, please specify statutory or other basis for such status: Does this case involve an amount under $100,000? Yes No Judgment or Order disposes of all parties and issues? Yes No Appeal from final judgment? Yes No Does the appeal involve the constitutionality or the validity of a statute, rule, or ordinance? Yes No VI. Actions Extending Time to Perfect Appeal Motion for New Trial: Yes No If yes, date filed: Motion to Modify Judgment: Yes No If yes, date filed: Request for Findings of Fact and Conclusions of Law: Yes No If yes, date filed: Motion to Reinstate: Yes No If yes, date filed: Motion under TRCP 306a: Yes No If yes, date filed: Other: Yes No If Other, please specify: American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 11 V II . Indigency of Party (Attach file stamped copy of Statement and copy of the trial court order. ) Was Statement of Inability to Pay Court Costs filed in the trial court? Yes No If yes, date filed: Was a Motion Challenging the Statement filed in the trial court? Yes No If yes, date filed: Was there any hearing on appellant222s ability to afford court costs? Yes No Hearing Date: Did trial court sign an order under Texas Rule of Civil Procedure 145? Yes No Date of Order: If yes, trial court finding: Challenge Sustained Overruled VI I I. Bankruptcy Has any party to the court222s judgment filed for protection in bankruptcy which might affect this appeal? Yes No If yes, please attach a copy of the petition. Date bankruptcy filed: Bankruptcy Case Number: IX . Trial Court and Record Court: County: Trial Court Docket No. (Cause No.): Trial Court Judge (who tried or disposed of the case): Name: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Clerk222s Record Trial Court Clerk: District County Was Clerk222s record requested? Yes No If yes, date requested: If no, date it will be requested: Were payment arrangements made with clerk? Yes No Indigent (Note: No request required under TRAP 34.5(a),(b).) American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 11 IX . Trial Court and Record - Continued Reporter222s or Recorder222s Record Is there a Reporter222s Record? Yes No Was Reporter222s Record requested? Yes No If yes, date requested: If no, date it will be requested: Was the Reporter222s Record electronically recorded? Yes No Were payment arrangements made with the court reporter/court recorder? Yes No Indigent Court Reporter Court Recorder Official Substitute Name: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: Court Reporter Court Recorder Official Substitute Name: Address 1: Address 2: City/State/Zip: Tel. Ext. Fax: Email: X . Supersedeas Bond Supersedeas bond filed? Yes No If yes, date filed: If no, will file? Yes No X I. Ex traordinary 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: American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 11 X II. Alternative Dispute Resolution/Mediation (Complete sectio n if filing in the 1 st , 2 nd , 4 th , 5 th , 6 th , 8 th , 10 th , 11 th , 13 th , or 14 th Court of Appeal s. ) Should this appeal be referred to mediation? Yes No If no, please specify: Has this case been through an ADR procedure? Yes No If yes, who was the mediator? What type of ADR procedure? At what stage did the case go through ADR? Pre-Trial Post-Trial Other If other, please specify: Type of Case? Give a brief description of the issue to be raised on appeal, the relief sought, and the applicable standard for review, if known (without prejudice to the right to raise additional issues or request additional relief): How was the case disposed of? Summary of relief granted, including amount of money judgment, and if any, damages awarded. If money judgment, what was the amount? Actual damages: Punitive (or similar) damages: Attorney222s fees (trial): Attorney222s fees (appellate): Other: If other, please specify: Will you challenge this Court222s jurisdiction? Yes No Does judgment have language that one or more parties 223take nothing224? Yes No Does judgment have a Mother Hubbard clause? Yes No Other basis for finality: American LegalNet, Inc. www.FormsWorkFlow.com Page 7 of 11 X II. Alternative Dispute Resolution/Mediation - Continued (Complete section if filing in the 1 st , 2 nd , 4 th , 5 th , 6 th , 8 th , 10 th , 11 th , 13 th , or 14 th Court of Appeals.) Rate the complexity of the case (use 1 for least and 5 for most complex): 1 2 3 4 5 Please make my answer to the preceding questions known to other parties in this case? Yes No Can the parties agree on an appellate mediator? Yes No If yes, please give the name, address, telephone, fax, and email address: Name: Address: Telephone: Ext. Fax: Email: Languages other than English in which the mediator should be proficient: Name of the person filling out mediation section of docketing statement: X III . Related Matters List any pending or past related appeals before this, or any other Texas Appellate Court, by Court, Docket, and Style. Court: Docket: Style: Vs. Court: D