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SEVENTH DISTRICT COURT OF APPEALS Civil Docketing Statement ________________________________ ________________________________ Plaintiff(s)-Appell______(s), v. ________________________________ ________________________________ Defendant(s)-Appell______(s). Lead counsel for each plaintiff: ) ) ) ) ) ) ) ) ) ) ) )

Appeals Case No. _________________ Trial Court Case No. _______________ Trial Court Judge _________________

Lead counsel for each defendant:

(Attach sheet to identify additional parties & counsel) (Attach sheet to identify additional parties & counsel)

Name/Reg. No:________________________ Firm Name: __________________________ Address: _____________________________ _____________________________________ Phone No. ____________________________ Fax No. ______________________________ Party (Appellant/Appellee) _________________

Name/Reg.: _________________________ Firm Name:__________________________ Address: ____________________________ ____________________________________ Phone No. ___________________________ Fax No. _____________________________ Party (Appellant/Appellee) ________________

______________________________________________________________________________ Date Notice of Appeal Filed ______________ File Date of Order being Appealed ___________ If applicable: Date & type of motion(s) per App. R. 4(B)(2) filed ______________________________ Date of Order resolving motion(s) ____________________________________________ Date docket record shows notice of final order mailed by clerk ___________________________ Is a transcript of proceedings to be filed? [ ] Yes [ ] No Does appeal involve: [ ] Summary Judgment [ ] Motion to Dismiss [ ] Grant/vacate default judgment [ ] N/A

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Is Oral Argument requested? [ ] Yes [ ] No Must this case be expedited as being one of the following types - [ ] Yes [ ] No [ [ [ ] ] ] Appeal brought by minor child (R.C. 2505.073 & Appellate Rule 11.2) Appeal from an order granting or denying adoption or permanently terminating parental rights (Appellate Rule 11.2) Appeal regarding an order concerning a dependent, abused, neglected, unruly or delinquent child (Appellate Rule 11.2) 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 (R.C. 3109.04(H) and 3109.06.) Juvenile Rule 22(F) Appeal [ ] Other: _____________________________

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Final appealable order: (a) Has the trial court disposed of all claims by and against all parties? [ ] Yes. Attach all judgments/orders resolving all claims against all parties. [ ] No. (b) If the answer to (a) is "no," has the trial court made an express determination that there is "no just reason for delay," per Civ. R. 54(B), with respect to the judgment/order from which the appeal is taken? [ ] Yes, in the same judgment or order. [ ] Yes, in a subsequent order dated _________. Attach subsequent order. [ ] No. (c) Is the judgment/order subject to interlocutory appeal per R.C. 2505.02 (check all that apply)? [ ] Yes. The order affects a substantial right in an action and prevents a judgment. R.C. 2505.02(B)(1) [ ] Yes. The order was made in a special proceeding. R.C. 2505.02(B)(2). [ ] Yes. The order grants or denies a provisional remedy and meets the other criteria of R.C. 2505.02(B)(4). [ ] Yes. The order determines that an action may or may not be maintained as a class action. See R.C. 2505.02(B)(5). [ ] No. (d) Does the right to an immediate appeal arise from a statute other than R.C. 2505.02? [ ] Yes. Identify statute: __________________________________________. [ ] No.

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NATURE OF CASE [ ] Original action [ ] Juvenile [ ] Probate [ ] Personal Injury [ [ [ [ [ ] Domestic Relations ] General Civil Appeal ] Contract [ ] Declaratory Judgment ] Medical Malpractice [ ] Administrative Appeal ] Other, specify ______________________________________

Was a stay of execution sought in the trial court?[ ] Yes [ ] No If Yes: granted/appealed/denied. Is a stay request being filed with this court? [ ] Yes. [ ] No. Have the parties to this appeal been parties to a previous appeal filed in this court? [ ] Yes [ ] No. If yes, please cite the case(s) _____________________________________. Do you know of another case(s) pending before this court or recently decided by this court which raises the same issue? [ ] Yes. [ ] No. If yes, please cite the case(s). ___________________ ______________________________________________________________________________ Summary Probable issues for review: 1. ____________________________________________________________________________ 2. ____________________________________________________________________________ 3. ____________________________________________________________________________ 4. ____________________________________________________________________________ Does the appeal turn on an interpretation or application of a particular case(s) or statute(s)? [ ] Yes. [ ] No. If yes, please cite the case(s) and/or statute(s). ________________________ ______________________________________________________________________________ CERTIFICATION I certify that the information provided on this docketing statement is accurate.

____________________________________ Signature of counsel or unrepresented party

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