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IN THE Circuit Court of the Second Circuit
(Court or Agency From Which Appeal is Taken)

CIVIL APPEAL DOCKETING STATEMENT
(For use by the Appellate Conference Program)

INTERNAL USE ONLY

Reset Form

PLEASE TYPE OR PRINT. ATTACH ADDITIONAL PAGES IF NECESSARY.
TITLE: Lower Court/Agency Docket Number: Is this a Cross-Appeal? Yes No

Has this manner previously been before the Hawaii Appellate Courts? If yes, state when? Case Name: Yes No

SC Docket Number: CHECK AS MANY AS APPLICABLE LOWER COURT/AGENCY DISPOSITION 1. STAGE OF PROCEEDINGS 2. TYPE OF JUDGMENT/ ORDER APPEALED ( ) Damages: Amount Sought: $_____________ Amount Granted 3. RELIEF

JURISDICTION 1. LOWER COURT/ AGENCY 2. APPELLATE

( ) Statutory ( ) Other Grounds (Specify)

( ) Final Decision of Lower Court/ Agency ( ) Interlocutory Decision ( ) Other (Specify)

( ) Pre-Trial ( ) During Trial ( ) After Trial

( ) Default Judgment ( ) Judgment/Court

Decision
( ) Dismissal/Jurisdiction ( ) Judgment/Jury Verdict ( ) Dismissal/Merits ( ) Summary Judgment ( ) Judgment NOV ( ) Declaratory Judgment ( ) Directed Verdict ( ) Other (Specify)

$_____________
( ) Injunctions: ( ) Preliminary ( ) Permanent ( ) Granted ( ) Denied ( ) Other (Specify)

BRIEF DESCRIPTION OF NATURE OF ACTION AND RESULT BELOW:

ANTICIPATED ISSUES PROPOSED TO BE RAISED ON APPEAL:

May the Mediator contact the trial judge to discuss this case? ________ Yes ________ No

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BASED ON YOUR PRESENT KNOWLEDGE: 1. Does this appeal involve a question of first impression or present a novel legal question? ________ Yes ________ No 2. Does this appeal involve a question of state or federal constitutional interpretation? ________ Yes ________ No 3. Does this case raise a question of law regarding the validity of a state tatute, county ordinance, or agency regulation? ________ Yes ________ No 4. Does this case involve issues upon which there is an inconsistency in the decisions of the Intermediate Court of Appeals or the Supreme Court? ________ Yes ________ No If yes, explain briefly: ____________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 5. Will the determination of this appeal turn on the interpretation or application of particular case or statute? ________ Yes ________ No If Yes, provide: Case name/statute: ____________________________________________________________________ Citation: ____________________________________________________________________________ Docket number, if unreported: ___________________________________________________________ 6. Is there any case now pending or about to be filed in this court or any other court or administrative agency which: a) Arises from substantially the same case or controversy as this appeal? ________ Yes ________ No b) Involves an issue that is substantially the same, similar or related to an issue in this appeal? ________ Yes ________ No Case name: _______________________________________________________________________ Citation: _____________________________ Court or agency: ______________________________ Docket Number, if unreported: ________________________________________________________ DOES THIS APPEAL INVOLVE ANY OF THE FOLLOWING: _______ Likelihood of a motion to expedite the appeal. _______ Multiple parties on either side for whom joint briefing is possible. _______ Likelihood of motions to intervene on appeal. _______ Likelihood of motions to file amicus briefs. _______ Likelihood of motions to stay appeal pending resolution of a related case. Identify case name, docket number, and court or agency: ______________________________________________ ____________________________________________________________________________ _______ Other procedural complexities. If so, please identify them: _____________________________ ____________________________________________________________________________ ____________________________________________________________________________ Page 3

COUNSEL FOR APPELLANT(S):

TRIAL COUNSEL FOR APPELLANT(S) (If different than Appeal Counsel) NAME: ____________________________________ ADDRESS: _________________________________ __________________________________________ TELEPHONE: ( 808 )_________________________

NAME: _____________________________ ADDRESS: __________________________ ____________________________________ TELEPHONE: ( 808 )__________________

I CERTIFY THAT A COPY OF THIS CIVIL APPEAL DOCKETING STATEMENT WAS SUBMITTED TO THE CLERK OF THE LOWER COURT/AGENCY AND THAT IT WAS SERVED ON EACH PARTY/COUNSEL SHOWN ON THE ATTACHED SERVICE LIST.

________________________________ Signature

_________________________________________ Date

REMEMBER TO ATTACH COPIES OF (1) THE ORDER/JUDGMENT APPEALED FROM, (2) ANY WRITTEN OPINION OR FINDINGS OF FACT AND CONCLUSIONS OF LAW SUPPORTING THE ORDER/JUDGMENT, AND (3) PROOF OF SERVICE ON ALL OTHER PARTIES TO THE PROCEEDINGS BELOW (WITH TELEPHONE NUMBERS)

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