Ohio Loc. App. R. Form III

As amended through October 29, 2024

Form III - Civil Docket Statement

1. Counsel for the appellant, or the appellant if pro se, must complete, serve, and file this docket statement at the time of filing the notice of appeal.

2. A copy of the judgment entry or order which is being appealed must be attached to the notice of appeal.

3. A copy of the order for the transcript of proceedings must be filed with the clerk and served on the court reporter at the time of filing the notice of appeal.

4. If less than the entire transcript of proceedings is to be included in the record, appellant must , at the time of filing the notice of appeal, file a statement of the assignments of error appellant intends to present on appeal.

Court of Appeals Case No.:________________ County:________________________

Case Caption:_____________________________________________________________

Counsel for appellant or appellant pro se:

Name:_______________Address and Telephone:________________________________

Email Address:_________________________

Counsel for appellee or appellee pro se:

Name:_______________Address and Telephone:________________________________

Email Address:_________________________

Trial Judge:________________________Trial Court Case No.:______________________

Date notice of appeal filed:_________________________

Date that judgment or order appealed from was filed:_________________________

Related Appeals Nos.:________________________________

Does this case involve multiple parties?	Yes___	No___
Does this case involve multiple claims?	Yes___	No___
Does Civ.R. 54(B) apply?	Yes___	No___
Is there a "no just reason for delay" certification?	Yes___	No___

Is there a "no just reason for delay" certification?

Record (indicate type of record to be filed):_______________________________________

There will be a full____partial____transcript of the proceedings filed. If partial, designate parts:_______________________________________________

There will be an App.R. 9(C) statement:___

There will be an App.R. 9(D) agreed statement:___

No transcript, statement, or agreed statement to be filed:___

Has a notice of appeal been previously filed in this court concerning this case?

Yes__ No___

If yes, what was the previous appellate case number?_______________________

Nature of the case (for example, personal injury; administrative appeal; will contest; domestic relations; etc.):_____________________________

Is appellate counsel different from trial counsel?

Yes___ No___

Does this case turn upon an interpretation or application of a particular case(s) or statute(s)? Yes___ No___ If yes, please list the cases or statutes:_______________________________________________________________________________

How would you characterize the extent of your settlement discussions prior to judgment in the trial court? None___ Minimal___ Modest___ Extensive___

Have post-judgment settlement discussions occurred? Yes___ No___

Would a preliminary mediation conference be of any assistance in resolving this matter? (Note - the primary purpose of the mediation conference is to encourage the parties to explore any possibilities for the settlement of this case before incurring additional expenses, or, if settlement is not possible, to limit the issues on appeal.)

Yes___No___Please explain:__________________________________________________

TRANSCRIPT INFORMATION [App.R. 9(B)]

___I have ordered a complete transcript of proceedings from the court reporter.

___I have ordered a partial transcript of proceedings from the court reporter.

___A statement of the evidence pursuant to App.R. (C) or (D) is to be prepared in lieu of a transcript of proceedings.

___No transcript of proceedings or statement of the evidence pursuant to either App.R. 9(C) or (D) is necessary and I have notified the court reporter of that fact in writing pursuant to App.R. 9(B).

___The transcript of proceedings has been completed and already made part of the record.

Name:_______________________________

Attorney for:__________________________

Ohio. Loc. App. R. Form III

As amended effective 2/1/2021; as amended effective 3/2/2022.