Proposed Statement on Appeal Limited Civil Case

Proposed Statement on Appeal (Limited Civil Case) - APP-104

Instructions

• This form is only for preparing a proposed statement on appeal in a limited civil case.

• Before you fill out this form, read Information on Appeal Procedures for Limited Civil Cases (form APP-101-INFO) to know your rights and responsibilities.

• This form can be attached to your Notice Designating Record on Appeal (Limited Civil Case) (form APP-103). If it is not attached to that notice, this form must be filed no later than 20 days after you file that notice.

• Fill out this form and make a copy of the completed form for your records and for each of the other parties.

• Serve a copy of the completed form on each of the other parties and keep proof of this service.

• Take or mail the original completed form and proof of service on the other parties to the clerk’s office for the same court that issued the judgment or order you are appealing.

Court Information

Superior Court of California, County of

Trial Court Case Number:

Trial Court Case Name:

Appellate Division Case Number:

1. Your Information

a. Name of appellant:

b. Appellant’s contact information

Street address:

City: State: Zip:

Mailing address (if different):

City: State: Zip:

Phone: E-mail (optional):

c. Appellant’s lawyer

Name: State Bar number:

Street address:

City: State: Zip:

Mailing address (if different):

City: State: Zip:

Phone: Fax (optional): E-mail (optional):

2. Information About Your Appeal

On I/My client filed a notice of appeal in the trial court case identified above.

On I/My client filed a notice designating the record on appeal, electing to use a statement on appeal.

4. The Dispute

a. In the trial court, I/my client was the:

plaintiff

defendant

b. The plaintiff’s complaint in this case was about:

c. The defendant’s response to this complaint was:

Check here if you need more space to describe the dispute and attach separate pages.

5. Summary of Any Motions

a. Were any motions filed in this case?

Yes

No

b. Describe the motions made in the trial court and the rulings.

(1) Describe the first motion:

Filed by:

plaintiff defendant

There was was not a hearing on this motion.

The trial court granted this motion. did not grant this motion.

Other action:

(2) Describe the second motion:

Filed by:

plaintiff defendant

There was was not a hearing on this motion.

The trial court granted this motion. did not grant this motion.

Other action:

Check here if any other motions were filed and attach separate pages describing each motion.

6. Summary of Testimony

a. Was there a trial in your case?

No

Yes

Jury trial

Trial by judge only

b. Did you/your client testify at the trial?

No

Yes

c. Did anyone else testify at the trial?

No

Yes

Witness name:

Testified on behalf of:

plaintiff defendant

7. The Trial Court’s Findings

Did the trial court make findings in the case?

No

Yes

8. The Trial Court’s Judgment or Order

a. I/My client was required to:

pay the other party damages of $

do the following:

b. The other party was required to:

pay me/my client damages of $

do the following:

c. Other:

9. Reasons for Your Appeal

a. There was not substantial evidence that supported the judgment, order, or other decision I am appealing in this case:

b. The following error or errors about either the law or court procedure was/were made that caused substantial harm to me/my client:

(1) Describe the error:

Describe how you were/your client was harmed by the error:

(2) Describe the error:

Describe how you were/your client was harmed by the error:

(3) Describe the error:

Describe how you were/your client was harmed by the error:

Date: