Fill and Sign the Filing as an Indigent Form

OSCA (1-08) CR120 1 of 2 Rules 30.01, 81.08, 512.070 RSMo IN THE ______ JUDICIAL CIRCUIT COURT, __________________________, MISSOURI Judge or Division: Case Number: Appellate Number: Filing as an Indigent Plaintiff/Petitioner: Court Reporter: Sound Recording Equipment vs. Reporter’s Telephone: Number of Days of Trial: Date of Judgment/Sentence: (Attach a copy) Date Post Trial Motion Filed: Defendant/Respondent: Date Ruled Upon: Date Notice Filed: (Date File Stamp) Notice of Appeal Supreme Court of Missouri Court of Appeals: Western Eastern Southern Notice is given that ____________________________________ appeals from the judgment/decree entered in this action on _______________________ (date). Complete if Appeal is to Supreme Court of Missouri Jurisdiction of the Supreme Court is based on the fact that this appeal involves: (Check appropriate box) The validity of a treaty or statute of the United States The title to any state office in Missouri The punishment imposed is death The construction of the revenue laws of Missouri The validity of a statute or provision of the Constitution of Missouri If the basis of jurisdiction is validity of a United States treaty or statute, the validity of a Missouri statute or Constitutional provision or construction of Missouri revenue la ws, a concise explanation, together with suggestions, if desired, is required. This may be filed as part of or with th is notice of appeal or, in the alternative, may be filed within t en days after the notice of appeal is filed by filing it directly with the Clerk of the Supreme Court. See Rule 81.08(b) and (c) and Rule 30.01(f) and (g). Appellant’s Attorney/Bar Number Respondent’s Attorney(s)/Bar Number(s) (If multiple, list all or attach additional sheets) Address Address Telephone Fax Telephone Fax Appellant’s Name Respondent’s Name Address Address Telephone Telephone Brief Description of Case Date of Appeal Bond Amount of Bond Bond Attached Signature of Attorney or Appellant Date OSCA (1-08) CR120 2 of 2 Rules 30.01, 81.08, 512.070 RSMo Notice to Appellant’s Attorney Local rules may require supplemental documents to be filed. Please refer to the applicable rule for the district in which the appeal is being filed and fo rward supplements as required. Certificate of Service I certify that on ___________________ (date), I served a copy of the notice of appeal on the following parties, at the following address(es), by the method of service indicated. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ _________________________________________ Appellant or Attorney for Appellant Directions to Clerk Serve a copy of the notice of appeal in a manner as prescribed by Rule 43.01 on the attorneys of record of all parties to the judgment other than those taking the appeal and on all other parties who do not have an attorney . (A copy of the notice of appeal is to be sent to the Attorney General when the app eal involves a felony.) Transmit a copy of the notice of appeal to the clerk of the Supreme Cour t/Court of Appeals. If a party does not have an attorney, mail the notice to the party at his/her last known address. Clerk shall then fill in the memora ndum below. (See Rules 81.08(d) and 30.01 (h) and (i).) Forward the docket fee to the Department of Revenue as required by statute. Memorandum of the Clerk I have this day served a copy of this notice by regular mail registered mail certified mail facsimile transmission to each of the following persons at the address stated below. If served by facsimile, include the time and date of transmission and the telephone number to which the document was transmitted. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ I have also transmitted a copy of the notice of appeal to the clerk of the Supreme Court Court of Appeals, _________________________ District Docket fee in the amount of $_____________ has been received by this clerk which will be disb ursed as required by statute. A copy of an order granting leave to appeal as indigent. ______________________________ _________________________________________ Date Clerk