FOR USE BY DISTRICT COURT PERSONNEL ONLY TRANSMISSION FORM District Court: District Court Case No.: Court of Appeals Case No.: SHORT CAPTION ______________________________ , Plaintiff/Petitioner ______________________________ vs. Date Filed: , Defendant/Respondent Case Manager: APPEAL INFORMATION to be completed by the Sixth Circuit
*provide pro se address IF NOT on the docket sheet ANYTHING THAT NEEDS SPECIAL ATTENTION: District Court Judge: Court Reporter(s):
From Deputy Clerk: Date:
$255.00 Appeal filing fee paid?
RECORD TRANSMISSION I hereby certify that I have transmitted to the United States Court of Appeals for the Sixth Circuit the annexed documents consisting of: Pleading(s) (including the pre-sentence report; state court pleadings, etc.) __________ volume(s) Deposition(s) __________ volume(s) Exhibit(s) __________ volume(s) Transcript(s) __________ volume(s) Sealed __________ volume(s). **Please indicate if this is a supplemental record: _______ Yes
December which constitutes the CERTIFIED RECORD ON APPEAL, this ______ day of _____________,20______.
Deputy Clerk,__________________________________ United States District Court