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OHIO FIFTH DISTRICT COURT OF APPEALS |
WARNING: |
A time-stamped copy of the judgment being appealed must attached to this Statement. |
WARNING: |
All requested information must be provided. Failure to file a fully completed docketing statement, typed or legibly printed, may result in this appeal being dismissed by the court, sua sponte. |
| _______________________________ | Appeal No.: | __________________ |
| _______________________________ | Trial Court No.: | __________________ |
| Plaintiff-Appellant Appellee (Circle One) | Trial Court Judge: | __________________ |
| vs. |
| ______________________________ | Plaintiff's Counsel: | __________________ |
| ______________________________ | Phone No.: | __________________ |
| Defendant-Appellant Appellee (Circle One) | Defendant's Counsel: | __________________ |
| Phone No. | __________________ |
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A. |
DATES: |
Of the judgment being appealed:_________ |
Of the filing of the Notice of Appeal:____________ |
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B. |
PROBABLE ISSUES FOR REVIEW: |
(Including charges in criminal case) |
_______________________ |
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____________________________________________________________________________________________ |
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____________________________________________________________________________________________ |
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C. |
THIS APPEAL SHOULD BE ASSIGNED TO: |
(Check One) |
(See Loc.R. 6(B) and App.R. 11.2) |
| ( | ) |
The regular calendar |
| ( | ) |
The accelerated calendar (See Loc.R. 6(B)) |
| ( | ) |
The expedited calendar (See Section F(3) on page two of this docketing statement and App.R. 11.2) |
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D. |
THE RECORD: |
This Docketing Statement will serve as a praecipe to the Clerk to prepare and transfer the docket and journal entries |
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Please indicate the type of record to be filed: (Check One) |
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| ( | ) |
Docketing and Journal Entries only, no transcript of proceedings. |
| ( | ) |
Statement of the Record pursuant to App.R. 9(C). |
| ( | ) |
Agreed Statement of the Record pursuant to App.R. 9(D). |
| ( | ) |
Transcript of Proceedings. |
( | ) |
Less than or |
( | ) |
Greater than 100 pages. |
| ( | ) |
Full or |
( |
) |
Partial transcript has been ordered. If partial, see App.R. 9(B) |
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WARNING: |
If a transcript of proceedings is needed, a copy of the notice of appeal and an appropriate praecipe must |
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be served by appellant on the court reporter. A copy of the praecipe to the court reporter shall be filed |
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with this Court showing service of the notice of appeal and praecipe upon the court reporter. |
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NAME OF COURT REPORTER, DATE SERVED: |
____________________________________ |
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Please state with particularity which exhibits and/or evidence, other than paper exhibits or documentary evidence not of |
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usual bulk or weight, the parties request be transmitted as part of the record on appeal. (See App.R. 10(B); Loc.App.R. 8(C)) |
| _______________________________________________________________________________ |
| _______________________________________________________________________________ |
| _______________________________________________________________________________ |
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E. CRIMINAL CASE |
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1. |
CHARGE: |
___________________________________________________________________________ |
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2. |
DEGREE: |
( |
) |
Misdemeanor |
( |
) |
Felony |
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3. |
Is this an appeal of probation revocation? |
( |
) |
Yes |
( |
) |
No |
If yes, what was the original charge and sentence? |
|
_____________________________________________________________________________________________ |
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4. |
Is this an appeal of Post-Conviction Relief? RC 2953.21 |
( |
) |
Yes |
( |
) |
No |
If yes, was a hearing held in the |
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trial court? |
( |
) |
Yes |
( |
) |
No |
What was the original charge and sentence?____________________________ |
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5. |
Type of appeal: (check one) |
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( |
) |
Appeal as of Right |
( |
) |
State's Appeal as of Right (RC 2945.67(A)) |
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( |
) |
Appeal by Leave of Court (App.R. 5) |
( |
) |
State's Appeal by Leave of Court |
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6. |
Is this an appeal for review of sentencing pursuant to RC 2953.08? |
( |
) |
Yes |
( |
) |
No |
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7. |
Was counsel appointed for trial? |
( |
) |
Yes |
( |
) |
No |
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8. |
Was counsel appointed for appeal? |
( |
) |
Yes |
( |
) |
No |
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9. |
Was a stay of sentence requested in trial court? |
( |
) |
Yes |
( |
) |
No |
If yes, stay was: GRANTED DENIED PENDING |
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F. CIVIL CASE
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1. |
ACTION BROUGHT IN LOWER COURT: |
_____________________________________________________ |
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____________________________________________________________________________________________ |
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2. |
Did this action originate in a Trial Court or in an Administrative Agency? |
Indicate which: |
|
( |
) |
County Court |
( |
) |
Municipal Court |
( |
) |
Common Pleas Court |
( |
) |
Administrative Agency |
|
( |
) |
Probate Court |
( |
) |
Family Court |
( |
) |
Juvenile Court |
( |
) |
Other _____________ |
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3. |
Must this case be expedited as being one of the following types: |
( |
) |
Yes |
( |
) |
No |
If yes, check one of the following: |
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( |
) |
Appeal under determination of local fiscal emergency brought by municipal corporation RC 118.04(C) |
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( |
) |
Appeal brought by minor child under RC 2505.073 |
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( |
) |
Appeal involving matters of child custody, allocation of parental rights or responsibilities, or designation |
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of a child's place of residence and legal custodian under RC 3109.04(H) and RC 3109.06 |
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( |
) |
Appeal from orders granting or denying (1) termination of parental rights or (2) adoption of a minor child. |
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(See App.R. 11.2 effective July 1, 2000) See Loc.R. 7 |
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( |
) |
Appeal from orders regarding dependent, abused, neglected, unruly, or delinquent children |
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(See App.R. 11.2 effective July 1, 2000) See Loc.R. 7 |
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( |
) |
Election contests as provided in RC 3515.08 |
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4. |
Do you know of another case pending in this Court which raises the same issues(s)? |
( |
) |
Yes |
( |
) |
No |
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If yes, please cite case(s): |
__________________________________________________________________ |
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5. |
Have you determined in good faith that the judgment appealed from is a final appealable order? (RC 2505.02) |
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( |
) |
Yes |
( |
) |
No |
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6. |
Did the judgment dispose of all claims by and against all parties? |
( |
) |
Yes |
( |
) |
No |
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7. |
If not, is there an express determination that there is "no just reason for delay"? Civ.R. 54(B) |
( |
) |
Yes |
( |
) No |
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8. |
Was a stay of judgment requested in trial court? |
( |
) |
Yes |
( |
) |
No |
If yes, stay was: |
GRANTED DENIED PENDING |
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CERTIFICATION |
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I certify that the information provided on this Docketing Statement is accurate. |
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__________________________________________ |
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Signature of Counsel (or Party if not represented by Counsel) |
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Supreme Court Registration No.:__________________ |
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Effective: June 1, 2003 |