Free Civil Appeals Screening Statement (CASS) (rev. 2008) - District of Columbia

District of Columbia Court of Appeals
Washington, D. C. 20001 Civil Appeals Screening Statement
App. No. __________________ Superior Ct. No. ____________ 1. Full caption: 2. Case type and a brief description of the facts that caused the initial dispute, including any injuries on which the claim for compensation is based, if applicable: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Nature of disposition below: Attach a copy of the order(s) on appeal to this form. Bench trial Dismissal Jury verdict Forum non conveniens Summary judgment Lack of jurisdiction Grant/denial of injunction Failure to state a claim Default judgment Failure to prosecute Other (specify) ________________________________________________________ 4. State concisely the principal issue(s) in this appeal and the standard of review governing each: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 5. Does this appeal present any new question of law? If yes, what is that question: yes no

_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
Open to All Trusted by All Justice for All

6. Nature of relief sought below: Damages: Amount sought $ _________ Injunctive relief: Temporary Granted Amount received $ _________ Preliminary Denied Granted Permanent

Declaratory relief:

Denied

Attorney fees: Amount sought $ ________

Amount received $ ________

7. Are there any factors that may influence the suitability of mediation? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ I certify that the above information is accurate to the best of my knowledge.

_____________________________________ Signature Name _______________________________ Bar No. ______________________________ Address ______________________________ ______________________________ Telephone No. _________________________ CERTIFICATE OF SERVICE I hereby certify that a copy of this screening statement was served by hand/mailed, first class postage prepaid, this _____________ day of _____________, 20___, on the following:

Signature: ________________________________

Open to All Trusted by All Justice for All