Writ Application Filing Sheet

SUPREME COURT OF LOUIS IANA WRIT APPLICATI ON FILI NG SHEET NO._______________________ ____________ TO BE C OMPLET ED BY C OUNSE L or PRO S E LI TI GANT F IL ING APPL ICA TI ON TITLE Applicant:_______________________________________ Have there been any other filings in this ______________________________________ Court in this matter? G Yes G No VS . Are you seeking a Stay Order?_____ Priority Treatment?_____ ______________________________________ If so you M US T complete & attach a Priority Form LEAD C OUNSEL /PRO SE LI TIGA NT INFORMATI ON APPLICANT: RESPONDENT: Name:_________________________________________ Name:__________________________________________ Address:_______________________________________ Address:________________________________________ ________________________________________ ________________________________________ PhoneNo._______________ Bar Roll No.____________ PhoneNo._______________ Bar Roll No.____________ Pleading being filed: G In proper person, G In Forma Pauperis Attach a list of additional counsel/pro se litigants, their addresses, phone numbers and the parties they represent. TYPE OF P LEADI NG G Civil, G Criminal, G R.S. 46:1844 protection, G Bar, G Civil Juvenile, G Criminal Juvenile, G Other G CINC, G Termination, G Surrender, G Adoption, G Child Custody ADMIN IS TRATI VE OR MUNI CIP AL COUR T I NFORMATI ON Tribunal/Court:_________________________________________ Docket No.________________________________ Judge/Commissioner/Hearing Officer:________________________________ Ruling Date:_____________________ DIS TRI CT COUR T I NFORMATI ON Parish and Judicial District Court:____________________________________Docket Number:__________________ Judge and Section:______________________________________Date of Ruling/Judgment:_____________________ APPE LLAT E COURT INF ORMATI ON Circuit:__________ Docket No.__________________ Action:____________________________________________ Applicant in Appellate Court:_______________________________________________ Filing Date:________________ Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G REHEAR ING INF ORMATI ON Applicant:_________________________________ Date Filed:___________ Action on Rehearing:_______________ Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G PRESE NT STATU S G Pre-Trial, Hearing/Trial Scheduled date:_____________________________, G Trial in Progress, G Post Trial Is there a stay now in effect?______ Has this pleading been filed simultaneously in any other court?______ If so, explain briefly_________________________________________________________________________________ _______________________________________________________________________________________________. VERIFI CATION I certify that the above information and all of the information contained in this application is true and correct to the best of my knowledge and that all relevant pleadings and rulings, as required by Supreme Court Rule X, are attached to this filing. I further certify that a copy of this application has been mailed or delivered to the appropriate court of appeal (if required), to the respondent judge in the case of a remedial writ, and to all other counsel and unrepresented parties. DATE SIGNATURE C:\Documents and Settings\clemann\Local Settings\Temp\Filing Sheet.wpd Revised 10-11-2002