Free Appendix C Writ Application Filing Sheet - Louisiana

SUPREME COURT OF LOUISIANA WRIT APPLICATION FILING SHEET NO.___________________________________ TO BE COMPLETED BY COUNSEL or PRO SE LITIGANT FILING APPLICATION TITLE ______________________________________ VS. ______________________________________ Applicant:_______________________________________ Have there been any other filings in this Court in this matter? G Yes G No Are you seeking a Stay Order?_____ Priority Treatment?_____ If so you MUST complete & attach a Priority Form

LEAD COUNSEL/PRO SE LITIGANT INFORMATION 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 PLEADING 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

ADMINISTRATIVE OR MUNICIPAL COURT INFORMATION Tribunal/Court:_________________________________________ Docket No.________________________________ Judge/Commissioner/Hearing Officer:________________________________ Ruling Date:_____________________ DISTRICT COURT INFORMATION Parish and Judicial District Court:____________________________________Docket Number:__________________ Judge and Section:______________________________________Date of Ruling/Judgment:_____________________ APPELLATE COURT INFORMATION Circuit:__________ Docket No.__________________ Action:____________________________________________ Applicant in Appellate Court:_______________________________________________ Filing Date:________________ Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G REHEARING INFORMATION Applicant:_________________________________ Date Filed:___________ Action on Rehearing:_______________ Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G PRESENT STATUS 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_________________________________________________________________________________ _______________________________________________________________________________________________.
VERIFICATION

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
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SIGNATURE
Revised 10-11-2002