) v. ) ) ____________________________ ) Defendant ) Notice of Appeal to United States Court of Appeals for the _____ Circuit _______________, the plaintiff [or defendant or other party] appeals to the United States Court of Appeals for the _____ Circuit from the final judgment [or order or decree] of the district court for the district of __________ [or bankruptcy appellate panel or the _____ circuit], entered in this case on _______________, 20_____ [here describe the judgment, order, or decree] ___________________________________. The parties to the judgment [or order or decree] appealed from and the names and addresses of their respective attorneys are as follows: Dated ________________________________ Signed ________________________________ Attorney for Appellant Address: ______________________________ (As added Apr. 25, 1989, eff. Dec. 1, 1989; Apr 1, 1993, eff. Dec. 1, 1993.) Form 6. Civil Appeals Docketing Statement (SEAL) Page 1 of 2 USCA DOCKET # (IF KNOWN) UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CIVIL APPEALS DOCKETING STATEMENT PLEASE ATTACH ADDITIONAL PAGES IF NECESSARY. TITLE IN FULL: DISTRICT: JUDGE: DISTRICT COURT NUMBER: DATE NOTICE OF APPEAL FILED: IS THIS A CROSS APPEAL? __ YES IF THIS MATTER HAS BEEN BEFORE THIS COURT PREVIOUSLY, PLEASE PROVIDE THE DOCKET NUMBER AND CITATION (IF ANY): BRIEF DESCRIPTION OF NATURE OF ACTION AND RESULT BELOW: PRINCIPAL ISSUES PROPOSED TO BE RAISED ON APPEAL: PLEASE IDENTIFY ANY OTHER LEGAL PROCEEDINGS THAT MAY HAVE A BEARING ON THIS CASE (INCLUDE PENDING DISTRICT COURT POST-JUDGMENT MOTIONS): DOES THIS APPEAL INVOLVE ANY OF THE FOLLOWING: __ Possibility of settlement __ Likelihood that intervening precedent will control outcome of appeal __ Likelihood of a motion to expedite or to stay the appeal, or other procedural matters (Specify)________________________________________________________________________________ __ Any other information relevant to the inclusion of this case in the Mediation Program_______________________ __________________________________________________________________________________________ __________________________________________________________________________________________ ___________________ Possibility parties would stipulate to binding award by Appellate Commissioner in lieu of submission to judges

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