OHIO FIFTH DISTRICT COURT OF APPEALS
DOCKETING STATEMENT

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. __________________

A.

DATES:

Of the judgment being appealed:_________

Of the filing of the Notice of Appeal:____________

B.

PROBABLE ISSUES FOR REVIEW:

(Including charges in criminal case)

_______________________

____________________________________________________________________________________________

____________________________________________________________________________________________

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)

D.

THE RECORD:

This Docketing Statement will serve as a praecipe to the Clerk to prepare and transfer the docket and journal entries

Please indicate the type of record to be filed: (Check One)

( )

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)

WARNING:

If a transcript of proceedings is needed, a copy of the notice of appeal and an appropriate praecipe must

 

be served by appellant on the court reporter. A copy of the praecipe to the court reporter shall be filed

 

with this Court showing service of the notice of appeal and praecipe upon the court reporter.

 

NAME OF COURT REPORTER, DATE SERVED:

____________________________________

Please state with particularity which exhibits and/or evidence, other than paper exhibits or documentary evidence not of

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))

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

E. CRIMINAL CASE

1.

CHARGE:

___________________________________________________________________________

2.

DEGREE:

(

)

Misdemeanor

(

)

Felony

3.

Is this an appeal of probation revocation?

(

)

Yes

(

)

No

If yes, what was the original charge and sentence?

_____________________________________________________________________________________________

4.

Is this an appeal of Post-Conviction Relief? RC 2953.21

(

)

Yes

(

)

No

If yes, was a hearing held in the

 

trial court?

(

)

Yes

(

)

No

What was the original charge and sentence?____________________________

5.

Type of appeal: (check one)

 

(

)

Appeal as of Right

(

)

State's Appeal as of Right (RC 2945.67(A))

 

(

)

Appeal by Leave of Court (App.R. 5)

(

)

State's Appeal by Leave of Court

6.

Is this an appeal for review of sentencing pursuant to RC 2953.08?

(

)

Yes

(

)

No

7.

Was counsel appointed for trial?

(

)

Yes

(

)

No

8.

Was counsel appointed for appeal?

(

)

Yes

(

)

No

9.

Was a stay of sentence requested in trial court?

(

)

Yes

(

)

No

If yes, stay was: GRANTED DENIED PENDING

F. CIVIL CASE

1.

ACTION BROUGHT IN LOWER COURT:

_____________________________________________________

____________________________________________________________________________________________

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 _____________

3.

Must this case be expedited as being one of the following types:

(

)

Yes

(

)

No

If yes, check one of the following:

(

)

Appeal under determination of local fiscal emergency brought by municipal corporation RC 118.04(C)

(

)

Appeal brought by minor child under RC 2505.073

(

)

Appeal involving matters of child custody, allocation of parental rights or responsibilities, or designation

 

of a child's place of residence and legal custodian under RC 3109.04(H) and RC 3109.06

(

)

Appeal from orders granting or denying (1) termination of parental rights or (2) adoption of a minor child.

 

(See App.R. 11.2 effective July 1, 2000) See Loc.R. 7

(

)

Appeal from orders regarding dependent, abused, neglected, unruly, or delinquent children

 

(See App.R. 11.2 effective July 1, 2000) See Loc.R. 7

(

)

Election contests as provided in RC 3515.08

4.

Do you know of another case pending in this Court which raises the same issues(s)?

(

)

Yes

(

)

No

If yes, please cite case(s):

__________________________________________________________________

5.

Have you determined in good faith that the judgment appealed from is a final appealable order? (RC 2505.02)

(

)

Yes

(

)

No

6.

Did the judgment dispose of all claims by and against all parties?

(

)

Yes

(

)

No

7.

If not, is there an express determination that there is "no just reason for delay"? Civ.R. 54(B)

(

)

Yes

(

) No

8.

Was a stay of judgment requested in trial court?

(

)

Yes

(

)

No

If yes, stay was:

GRANTED DENIED PENDING

CERTIFICATION

I certify that the information provided on this Docketing Statement is accurate.

 

__________________________________________

Signature of Counsel (or Party if not represented by Counsel)

Supreme Court Registration No.:__________________

Effective: June 1, 2003