Challenge to Constitutionality of a State Statute This form must be completed by a party filing a petition, motion or other pleading challenging the constitutionality of a state statute. The completed form must be filed with the court in which the cause is pending as required by Section 402.010 (a-1), Texas Government Code. Cause Number (For Clerk Use Only): Styled: (e.g., John Smith v. All American Insurance Co.; in re Mary Ann Jones; In the Matter of the Estate of George Jackson) Court (For Clerk Use Only): Contact information for party* challenging the constitutionality of a state statute. (*If party is not a person, provide contact information for party, party's representative or attorney.) Name: Address: City/State/Zip: Email: Person completing this form is: Attorney for Party Telephone: Fax: State Bar No. (if applicable): Unrepresented Party Other: Identify the type of pleading you have filed challenging the constitutionality of a state statute. Petition Answer Motion (Specify type): Other: Is the Attorney General of the State of Texas a party to or counsel in this cause? Yes No List the state statute(s) being challenged in your pleading and provide a summary of the basis for your challenge. (Additional pages may be attached if necessary.) 9/5/13 American LegalNet, Inc. www.FormsWorkFlow.com