Free Agency Docketing Statement - District of Columbia

UNITED STATES COURT OF APPEALS DISTRICT OF COLUMBIA CIRCUIT
333 Constitution Avenue, NW Washington, DC 20001-2866 Phone: 202-216-7000 | Facsimile: 202-219-8530

Administrative Agency Review Proceedings (To be completed by appellant/petitioner)

AGENCY DOCKETING STATEMENT 2. DATE DOCKETED:
v.

1. CASE NO. 3. CASE NAME (lead parties only)

Complaint 4. TYPE OF CASE: Enforcement Appeal Review 5. IS THIS CASE REQUIRED BY STATUTE TO BE EXPEDITED? Yes If YES, cite statute 6. CASE INFORMATION: a. Identify agency whose order is to be reviewed: b. Give agency docket or order number(s): c. Give date(s) of order(s): d. Has a request for rehearing or reconsideration been filed at the agency? If so, when was it filled? Has the agency acted? Yes By whom? No If so, when?

Tax Court No

Yes

No

e. Identify the basis of appellant's/petitioner's claim of standing. See D.C. Cir. Rule 15(c)(2):

f. Are any other cases involving the same underlying agency order pending in this Court or any other? Yes No If YES, identify case name(s), docket number(s), and court(s) g. Are any other caess, to counsel's knowledge, pending before the agency, this Court, another Circuit Court, or the Supreme Court which involve substantially the same issues as the instant case presents? Yes No If YES, give case name(s) and number(s) of these cases and identify court/agency:

h. Have the parties attempted to resolve the issues in this case through arbitration, mediation, or any other alternative for dispute resolution? Yes No If YES, provide program name and participation dates.

Signature Name of Counsel for Appellant/Petitioner Address E-Mail Note:

Date

Phone (

)

Fax (

)

ATTACH A CERTIFICATE OF SERVICE If counsel for any other party believes that the information submitted is inaccurate or incomplete, counsel may so advise the Clerk within 7 calendar days by letter, with copies to all other parties, specifically referring to the challenged statement.

USCA Form 41 August 2009 (REVISED)

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