Local Form A (for Criminal Appeals) FORM A - FOR APPEALS IN CRIMINAL CASES
CASE AND SENTENCING INFORMATION To be completed by Courtroom Deputy. CASE TITLE:
DISTRICT DO C K E T NO . JUDGE
Affidavit of Financial Status (CJA 23) [ ] Filed [ ] Unfiled DEFENDANT: Name and Address Leave to appeal In Forma Pauperis [ ] Granted [ ] Denied [ DEFENDANT'S ATTORNEY Name and Address ] Not Sought SOCIAL SECURITY NO.
ASSISTANT U.S. ATTORN EY: Name and Telephone
[ [ Date of Sentence Bail/Jail disposition [ ] Committed
Defendant found guilty by [ ] Plea ________
Number of other co-defendants found guilty:
To be com pleted by courtroom deputy. Was daily copy prepared?
Court Reporter in Charge: (Name , Telephone)
YES YES YES
NO NO NO
Did assistant U.S. Attorney order trial minutes? Did attorney for the defendant order trial minutes?
COUNSEL AND TRANSCRIPT INFORMATION ON APPEAL 1. Does defendant's financial status warrant appointment of counsel on appeal? If so, should trial counsel be appointed on appeal? YES NO
To be completed by sentencing judge 3. Should trial minutes be transcribed at the expense of the United States pursuant to CJA? YES NO
SIGNATURE OF JUDGE
NAME OF COURTROOM DEPUTY
DATE NOTICE OF APPEAL FILED
DISTRIBUTE COPIES TO THE FOLLOWING:
1. Original to U.S. District Court, (Appeals Clerk). 2. Copy to U.S. Court of Appeals.
3. Copy U.S. Attorney's Office. 4. Copy to Probation Office.
USCA-2 FORM A Rev. 10-02