Confidential Personal Identifiers Contained In Filing {13.2}

First District Court of Appeals Form II Rev. 3/95 Criminal Docket Statement (Must Be Filed In Duplicate and Served On Opposing Counsel) 1. Case Caption _____________________________________ vs. _________________________________ 2. Appeal No. ______________________ 3. Trial No. ________________________ 4. Trial Judge ______________________ 5. Related Appeals _________________ 6. Date of Judgment/ Order Appealed From ______________ 7. Date Appeal Filed ________________ 8. Counsel for Appellant 9. Counsel for Appellee E-Mail address 10(B) Criminal Status Counsel was appointed for trial Counsel was appointed for appeal Stay was granted by trial court Length of Sentence Yes No Yes No Yes No E-Mail address Counsel will make a reasonable effort to contact the client prior to merit hearing so that counsel can advise the court of the client's status and desire to proceed with the appeal. Yes No If answered no, please explain: __________________________________________________ Yes Yes No No 11. Record There will be a partial transcript of proceedings filed. The parts to be ordered are: There will be a complete transcript of proceedings filed. If either of the above is applicable the court reporter's certification below must be completed. If neither of the above are applicable then one of the following must be circled: There will be a statement filed pursuant to App. R. 9(C) Yes There will be an agreed statement filed pursuant to App. R. 9(D) Yes There is no transcript, statement or agreed statement to be filed. Yes Circling any of the above three will be deemed sufficient compliance with App. R. 9(C) and Local Rule 5. No No No 12. Court Reporter's Certification pages and pursuant to Local Rule 10, the transcript will be The transcript as ordered consists of approximately ___ prepared and ready for filing on ___________________________ Date: ___________________________ 13. Brief Upon the filing of the complete record I request __________ days to file the brief and assignments of error. 14. Nature of Appeal Please Check All That Apply and Provide Specific Information Whenever Space Is Provided. () DUI ( ) Arson () Kidnapping ( ) Assault () Murder ( ) Attempt () Death Penalty ( ) Automobile Offense () Post Conviction ( ) Burglary () Probation ( ) Complicity, Conspiracy () Robbery ( ) Drug Offense 15. Probable Issues for Review ( ) Counsel was Recently Appointed and is Not Yet Able to Identify Probable Issue(s) For Review. -ORPlease Check All That Apply and Provide Specific Information Whenever Space Is Provided. ( ) Allied Offenses ( ) Prosecutor Search and ( ) Constitutional Law Seizure ( ) Counsel ­ Effective Assistance ( ) Arrest ( ) Crim. R. 11 ( ) Miranda ( ) Expungement ( ) Warrant ( ) ID/Photos Other : ( ) Indictment/Complaint ( ) Sentencing ( ) Lesser Included Offenses ( ) Procedure/ Rules ( ) Probation 16. Case[s] and/or Statute[s] to be Discussed Signature: _______________________________________________ ( ( ( ( ( ) ) ) ) ) Sex Offense Theft Offense Traffic Offense Weapons Offense Other Trial Matters ( ) Evidence ( ) Expert Witnesses ( ) Jury Instructions Witnesses ( ) Other: ( ) Weight of Evidence 17. Certificate of Service I certify that I have mailed or otherwise delivered a copy of this docket statement to all counsel of record or the parties if unrepresented. Date: _____________________________ Signature: ___________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com