Page 1 of 11

Appellate Docket Number:

Appellate Case Style:

Vs.

Companion

Case(s):

Amended/Corrected Statement 

DOCKETING STATEMENT (Civil) Appellate Court: 

(to be filed in the court of appeals upon perfection of appeal under TRAP 32) 

NOTE: Because space for additional parties / attorneys is limited on this form, you can include the information on a separate document. As per TRAP 

32.1 and 9.4, please include party’s name and the name, address, email address, telephone number, fax number, if any, and State Bar Number of the 

party’s lead counsel. If the party is not represented by an attorney, that party’s name, address, telephone number, fax number should be provided. 

I. Appellant II. Appellant Attorney(s) - Continued

 Person Organization

Name:

 Pro Se

If Pro Se Party, enter the following information:

Address: 

City/State/Zip: 

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

II. Appellant Attorney(s)

 Lead Attorney

Name:

Bar No. 

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:
Page 2 of 11

III. Appellee IV. Appellee Attorney(s) - Continued

 Person Organization

Name:

 Pro Se

If Pro Se Party, enter the following information:

Address: 

City/State/Zip: 

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

IV. Appellee Attorney(s)

 Lead Attorney

Name:

Bar No.

Firm/Agency:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Lead Attorney

Name:

Bar No.

Firm/Agency:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:
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V. Perfection of Appeal, Judgment and Sentencing

Nature of Case (Subject matter or type of case):

Date Order or Judgment signed: Type of Judgment:

Date Notice of Appeal filed in Trial Court: 

If mailed to the Trial Court clerk, also give the date mailed:

Interlocutory appeal of appealable order: Yes No

If yes, please specify statutory or other basis on which interlocutory order is appealable (See TRAP 28):

Accelerated Appeal (See TRAP 28): Yes No 

If yes, please specify statutory or other basis on which appeal is accelerated: 

Parental Termination or Child Protection? (See TRAP 28.4): Yes No 

Permissive? (See TRAP 28.3): Yes No 

If yes, please specify statutory or other basis for such status: 

Agreed? (See TRAP 28.2): Yes No 

If yes, please specify statutory or other basis for such status: 

Appeal should receive precedence, preference, or priority under statute or rule? Yes No 

If yes, please specify statutory or other basis for such status: 

Does this case involve an amount under $100,000? Yes No 

Judgment or Order disposes of all parties and issues? Yes No 

Appeal from final judgment? Yes No 

Does the appeal involve the constitutionality or the validity of a statute, rule, or ordinance? 

If yes, you must also complete and file the Challenge to Constitutionality of a State Statute form. 

 Yes No

VI. Actions Extending Time to Perfect Appeal

Motion for New Trial: Yes No If yes, date filed: 

Motion to Modify Judgment: Yes No If yes, date filed: 

Request for Findings of Fact and Conclusions of Law: 

 Yes No If yes, date filed: 

Motion to Reinstate: Yes No If yes, date filed: 

Motion under TRCP 306a: Yes No If yes, date filed: 

Other: Yes No

If Other, please specify: 
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VII. Indigency of Party (Attach file stamped copy of Statement and copy of the trial court order.)

 Yes No

 Yes No

 Yes No

Was Statement of Inability to Pay Court Costs filed in the trial court?

If yes, date filed:

Was a Motion Challenging the Statement filed in the trial court? 

 If yes, date filed: 

Was there any hearing on appellant’s ability to afford court costs? 

Hearing Date: 

Did trial court sign an order under Texas Rule of Civil Procedure 145? Yes No

Date of Order: 

If yes, trial court finding: Challenge Sustained Overruled 

VIII. Bankruptcy

Has any party to the court’s judgment filed for protection in bankruptcy which might affect this appeal?

 Yes No

If yes, please attach a copy of the petition.

Date bankruptcy filed: 

Bankruptcy Case Number: 

IX. Trial Court and Record

Court: 

County: 

Trial Court Docket No. (Cause No.): 

Trial Court Judge (who tried or disposed of the case): 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Clerk’s Record

Trial Court Clerk: District County 

Was Clerk’s record requested? Yes No

 If yes, date requested: 

 If no, date it will be requested: 

Were payment arrangements made with clerk?

 Yes No Indigent 

(Note: No request required under TRAP 34.5(a),(b).)
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IX. Trial Court and Record - Continued

Reporter’s or Recorder’s Record

Is there a Reporter’s Record? Yes No

Was Reporter’s Record requested? Yes No 

If yes, date requested:

 If no, date it will be requested: 

Was the Reporter’s Record electronically recorded? Yes No

Were payment arrangements made with the court reporter/court recorder? Yes No Indigent 

 Court Reporter Court Recorder 

 Official Substitute 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

 Court Reporter Court Recorder 

 Official Substitute

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

X. Supersedeas Bond

Supersedeas bond filed? Yes No

If yes, date filed: 

 If no, will file? Yes No

XI. Extraordinary Relief

Will you request extraordinary relief (e.g., temporary or ancillary relief) from this Court? Yes No

 If yes, briefly state the basis for your request: 
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XII. Alternative Dispute Resolution/Mediation 

 (Complete section if filing in the 1st, 2nd, 4th, 5th, 6th, 8th, 10th, 11th, 13th, or 14th Court of Appeals.)

Should this appeal be referred to mediation? Yes No 

 If no, please specify: 

Has this case been through an ADR procedure? Yes No

If yes, who was the mediator?

 What type of ADR procedure? 

 At what stage did the case go through ADR? Pre-Trial Post-Trial Other

 If other, please specify:

Type of Case?

 Give a brief description of the issue to be raised on appeal, the relief sought, and the applicable standard for review, if 

known (without prejudice to the right to raise additional issues or request additional relief):

How was the case disposed of?

Summary of relief granted, including amount of money judgment, and if any, damages awarded.

 If money judgment, what was the amount? Actual damages: 

Punitive (or similar) damages:

Attorney’s fees (trial):

Attorney’s fees (appellate):

Other:

 If other, please specify:

Will you challenge this Court’s jurisdiction? Yes No

Does judgment have language that one or more parties “take nothing”? Yes No

Does judgment have a Mother Hubbard clause? Yes No

Other basis for finality: 
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XII. Alternative Dispute Resolution/Mediation - Continued

 (Complete section if filing in the 1st, 2nd, 4th, 5th, 6th, 8th, 10th, 11th, 13th, or 14th Court of Appeals.)

Rate the complexity of the case (use 1 for least and 5 for most complex): 1 2 3 4 5 

Please make my answer to the preceding questions known to other parties in this case? Yes No 

Can the parties agree on an appellate mediator? Yes No

If yes, please give the name, address, telephone, fax, and email address:

Name:

 Address: 

 Telephone: Ext.

Fax:

Email:

Languages other than English in which the mediator should be proficient: 

Name of the person filling out mediation section of docketing statement:

XIII. Related Matters

List any pending or past related appeals before this, or any other Texas Appellate Court, by Court, Docket, and Style.

Court: Docket:

Style:

 Vs.

Court: Docket:

Style:

 Vs.

Court: Docket:

Style:

 Vs.

Court: Docket:

Style:

 Vs.

Court: Docket:

Style:

 Vs.

Court: Docket:

Style:

 Vs.
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XIV. Pro Bono Program:

 (Complete section if filing in the 1st, 2nd, 3rd, 5th, 7th, 13th or 14th Court of Appeals.)

The Courts of Appeals listed above, in conjunction with the State Bar of Texas Appellate Section Pro Bono Committee 

and local Bar Associations, are conducting a program to place a limited number of civil appeals with appellate counsel 

who will represent the appellant in the appeal before this Court. 

The Pro Bono Committee is solely responsible for screening and selecting the civil cases for inclusion in the Program 

based upon a number of discretionary criteria, including the financial means of the appellant or appellee. If a case is 

selected by the Committee, and can be matched with appellate counsel, that counsel will take over representation of the 

appellant or appellee without charging legal fees. More information regarding this program can be found in the Pro Bono 

Program Pamphlet available in paper form at the Clerk's Office or on the Internet at http://www.tex-app.org. If your case 

is selected and matched with a volunteer lawyer, you will receive a letter from the Pro Bono Committee within thirty (30) 

to forty-five (45) days after submitting this Docketing Statement.

Note: there is no guarantee that if you submit your case for possible inclusion in the Pro Bono Program, the Pro Bono 

Committee will select your case and that pro bono counsel can be found to represent you. Accordingly, you should not 

forego seeking other counsel to represent you in this proceeding. By signing your name below, you are authorizing the 

Pro Bono committee to transmit publicly available facts and information about your case, including parties and 

background, through selected Internet sites and Listserv to its pool of volunteer appellate attorneys. 

Do you want this case to be considered for inclusion in the Pro Bono Program? Yes No 

Do you authorize the Pro Bono Committee to contact your trial counsel of record in this matter to answer questions the 

committee may have regarding the appeal? Yes No

Please note that any such conversations would be maintained as confidential by the Pro Bono Committee and the 

information used solely for the purposes of considering the case for inclusion in the Pro Bono Program. 

If you have not previously filed a Statement of Inability to Pay Court Costs and attached a file-stamped copy of that 

Statement, does your income exceed 200% of the U.S. Department of Health and Human Services Federal Poverty 

Guidelines? Yes No

These guidelines can be found in the Pro Bono Program Pamphlet as well as on the internet at 

http://aspe.hhs.gov/poverty/06poverty.shtml. 

Are you willing to disclose your financial circumstances to the Pro Bono Committee? Yes No

If yes, please attach a Statement of Inability to Pay Court Costs completed and executed by the appellant or appellee. 

Sample forms may be found in the Clerk's Office or on the internet at http://www.tex-app.org. Your participation in 

the Pro Bono Program may be conditioned upon your execution of a Statement under oath as to your financial 

circumstances. 

Give a brief description of the issues to be raised on appeal, the relief sought, and the applicable standard of review, if 

known (without prejudice to the right to raise additional issues or request additional relief; use a separate attachment, if 

necessary).
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XV. Signature

Signature of counsel (or Pro Se Party) Date

Printed Name State Bar No.

Electronic Signature (Optional) Name

XVI. Certificate of Service

The undersigned counsel certifies that this Docketing Statement has been served on the following lead counsel for all 

parties to the Trial Court’s Order or Judgment as follows on:

Signature of counsel (or Pro Se Party) Electronic Signature (Optional)

State Bar No.

Certificate of Service Requirements (TRAP 9.5(e)): A certificate of service must be signed by the person who made the service and 

must state:

(1) the date and manner of service;

(2) the name and address of each person served, and

(3) if the person served is a party’s attorney, the name of the party represented by the attorney.
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Please enter the following for each person served:

Date Served:

Manner Served: 

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Party:

Date Served:

Manner Served: 

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Party:

Date Served:

Manner Served: 

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Party:

Date Served:

Manner Served: 

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Party:

Date Served:

Manner Served: 

Name:

Bar No.

Firm/Agency: 

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. Fax: 

Email:

Party:
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Please enter the following for each person served that is not an attorney for a party:

Date Served:

Manner Served: 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email:

Date Served:

Manner Served: 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email:

Date Served:

Manner Served: 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email:

Date Served:

Manner Served: 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email:

Date Served:

Manner Served:

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email:

Date Served:

Manner Served: 

Name:

Address 1: 

Address 2: 

City/State/Zip:

Tel. Ext. 

Fax: 

Email: