Free Form #App.R. 15-1 - Indiana

Form #App.R. 15-1
IN THE INDIANA [SUPREME COURT/ COURT OF APPEALS/TAX COURT] CAUSE NO. _____________________

NAME, [Appellant/Petitioner/ Plaintiff/Defendant,] v. NAME, [Appellee/Respondent/ Plaintiff/Defendant.]

) ) ) ) ) ) ) ) )

[Appeal or petition] from the _________ ____________________________ Court. Trial Court case no.: ______________ _________________________________ The Honorable ____________________ ___________________________, Judge.

APPELLANT'S CASE SUMMARY (Appearance)
Party Information Party or parties that filed Notice of Appeal: Name: ___________________________ Tel. No.: _______________ (Only if unrepresented by counsel) Address:_______________________________________________________________________________ Attorney or attorneys representing party filing notice of appeal: Name: ____________________________________________ Attorney # _________________________ Address:_______________________________________________________________________________ Tel. No.:_______________ Fax No.:________________ E-Mail: _________________________________ Requesting service of orders and opinions of the Court by FAX: Yes 1 No 2 In forma pauperis: Yes [ ] No [ ] (if yes, attach proof of appointment or proof on indigency). Trial Information Date case commenced: ______________________ Date of Judgment/order:______________________ (Attach copy of judgment or order appealed from including findings and conclusions (civil) and sentencing order (criminal) Check the appropriate line(s) to show the ruling being appealed:
3 Administrative ruling 6 declaratory judgment 9 Directed verdict 12 Dismissed 4 Injunction 5 (Judgment notwithstanding the verdict) 7 Judgment (bench trial) 8 Judgment (probation revocation) 10 Judgment (guilty plea) 11 Summary judgment 13Judgment (jury verdict)

14 Other (specify) ______________________________________________________________ Is this a final judgment as to all claims and all parties? 15Yes 16 No If no, state the basis on which the judgment/order is immediately appealable. T.R. 54(B) 17 App.R. 14(A)(1-9) 18 App.R. 14(B) 19 Did the trial court issue an order sealing or excluding from public access all or any portion of the trial court records? 20 Yes 21 No If yes, attach copies of all orders and entries relating to the trial court's decision to seal or exclude information from public access. Check the appropriate line(s) best describing the nature of the case:
22 23 24 25 26 27 28 29 30 31 32 Attorney's fees Child custody/support Civil rights Construction law Contempt Contract law Corporate law Criminal law, Misdemeanor Criminal law, habitual felon Criminal law, probation revocation Criminal law, post conviction relief 36 37 38 39 40 41 42 43 44 45 46 Education law Employment and labor Environmental law Equitable distribution Guardianship Health care Insurance, auto Insurance, other Intentional torts Juvenile Landlord/tenant 51 Professional malpractice 52 Real property rights 53 Sanctions 54 Taxation 55 Termination of parental rights 56 Tort claims act 57 Unemployment compensation 58 Unfair and deceptive practices 59 Utilities 60 Wills, trusts, estates 61 Workers' compensation

Specify ______________________ 33 Debtor/creditor rights 34 Dissolution of marriage 35 Driver's license revocation

47 48 49 50

Municipal law Negligence Paternity Products liability

62 Wrongful death 63 Wrongful discharge 64 Zoning/annexation

65 Other_________________________________________________________________________________________

Synopsis of judgment and sentence, if applicable: _______________________________________ ________________________________________________________________________________ Record Information Date notice of appeal filed__________________ (Attach copy of notice of appeal) Date clerk's record due to be assembled:__________________________________ Transcript information: Court reporter responsible for preparing transcript (Name, address, telephone number): _____________________________________________________________________ Transcript ordered: Yes 66 No67 Payment arrangements made: Yes68 No69 If no, reason not ordered or made: __________________________________________ ______________________________________________________________________ Est. Transcript length ____ pp. Transcript due date: ______________________________________________ Appeal Information A short and plain statement of the anticipated issues on appeal:___________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ (Attach copy of motion to correct errors) Prior appeals in this case with cause number: __________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Related appeals with Cause Number (prior, pending, or potential): _________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Motion for oral argument will be filed: Yes 70 No 71 Undecided 72 Motion for pre-appeal conference will be filed: No 73 Yes 74 Purpose: Shorten record 75 Appellate ADR 76 Refine issues 77 Other 78 If civil case, was ADR used in the trial court? Yes 79 No 80 If criminal case, status of defendant: On bond 81 Incarcerated 82 Location: __________________________________________ I certify that this case does does not involve issues relating to child custody, child support, child visitation, paternity, termination of parental rights, CHINS, adoption, or any other issue entitled to priority by statute. I also certify that I have reviewed and complied, and will continue to comply, with the requirements of Indiana Administrative Rule 9(G)(4) to the extent it applies to this appeal. ____________________________________________ /s/ Attorney/or pro se litigant's signature

CERTIFICATE OF SERVICE I hereby certify that on this _______ day of _______________, 20_____, the forgoing was served upon the following counsel of record by [state method of service]: ________________________________________________________________________________________ ________________________________________________________________________________________ [List Counsel served (including name and address where served)]: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________ [Signature]