APP-105

Order Concerning Appellant's 
Proposed Statement on Appeal 
(Limited Civil Case)

The court has received and reviewed the Proposed Statement on Appeal 
(form APP-104) filed by the appellant on (fill in date):

The court makes the following order:

The court certifies that parts       through      of the statement as  
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proposed by the appellant are an accurate summary of the  
evidence and testimony that is relevant to the issues the appellant 
indicated in item      are the reason for this appeal. This statement 
is ready to be sent to the appellate division.

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Corrections are needed in order for parts       through      of the  
statement proposed by the appellant to be an accurate summary 
of the evidence and testimony that is relevant to the issues the 
appellant indicated in item      are the reason for this appeal.

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9

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1

2

a.

b.

Clerk stamps date here when form is filed.

Clerk fills in the name and street address of the 
court:
Superior Court of California, County of

A modified statement is attached to this order. This 
modified statement must be sent to the parties.

Clerk fills in the number and name of the case

Trial Court Case Number:

The appellant is ordered to prepare a statement 
incorporating the modifications listed below and to serve 
and file this modified statement.

Trial Court Case Name:

Clerk fills in the number below:

Appellate Division Case Number:

(1)

(2)

(a)

(b)

(c)

(3)

More corrections than could be listed above were needed in order for parts       through       of the  
statement proposed by the appellant to be an accurate summary of the testimony and other 
evidence that is relevant to the issues the appellant indicated in item       are the reasons for this 
appeal. A list of required modifications is attached. The appellant is ordered to prepare a statement 
incorporating these modifications and serve and file the modified statement.

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5

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Judicial Council of California, www.courts.ca.gov 
Revised March 1, 2014, Optional Form  
Cal. Rules of Court, rule 8.837(d)

Order Concerning Appellant's 
Proposed Statement on Appeal 
(Limited Civil Case)

APP-105, Page 1 of 2

Trial Court Case Name:

Trial Court Case Number:

c.

The proposed statement does not contain the following material required by rule 8.837. 

The appellant is ordered to prepare a new proposed statement that includes this material.

The trial court proceedings in this case were reported by a court reporter or officially recorded 
electronically under Government Code section 69957. Instead of correcting this statement, the court orders 
under rule 8.837(d)(6)(B) that a transcript be prepared as the record of these proceedings. (Check the 
court’s local rules to make sure the court has a rule providing that this option is available.)

This superior court has a local rule for the appellate division authorizing the use of an official electronic 
recording as the record of the oral proceedings. The trial court proceedings in this case were officially 
electronically recorded. Instead of correcting this statement, the court orders that a copy of that electronic 
recording be prepared as the record of these proceedings at the court’s expense.

Signature of trial court judicial officer

d.

e.

Date:

Revised March 1, 2014

APP-105, Page 2 of 2

Order Concerning Appellant's 
Proposed Statement on Appeal 
(Limited Civil Case)

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