Name of first Defendant 

Address: 

ddress: 

elephone No: 

    T

  A

  T

Case No: 

ourt of Appeals: 

Circuit: 

  C

Michigan Court of Appeals 
 
DOCKETING STATEMENT 
 

Please read before completing form. 
 

(cid:190) MCR 7.204(H) and 7.205(D)(3) require an appellant in a civil action to complete and file a 

docketing statement within 28 days after the claim of appeal is filed or the application for leave 
to appeal is granted.  Failure to timely file this document may lead to dismissal of the appeal.  
An appellee may respond by filing a separate docketing statement. 
 

(cid:190) This document will be used to screen the appeal for suitability and eligibility for the settlement 
conference program, and will be used to help resolve jurisdictional and transcript issues.  It is 
important that you complete this form accurately and legibly. 
 

(cid:190) The issues identified in the docketing statement do not limit appellant's presentation of the 

issues in appellant's brief.  Omission of an issue in the docketing statement will not provide a 
basis for a motion to strike appellant's brief. 

____________________________________     v     ______________________________________ 

  Appellant
  Appellee

  Appellant
  Appellee

elephone No: 

elephone No: 

Attorney Name:                                         Bar No:_______

Attorney Name:                                         Bar No:_______ 

2.         A bankruptcy or other proceeding has been filed which affects this Court's jurisdiction over this 

.        There are pending or prior appeals in the Court of Appeals or Supreme Court which arose out 

of the same transaction, lower court case, or between the same parties. 

Specify case name, lower court number, appellate court number(s), and citation, if available. 

.         I am aware of the following pending appeals in the Court of Appeals or Supreme Court raising 

  the same or closely related issues. 

Specify case name, lower court number, appellate court number(s), and citation, if available. 

1 

.  Case Name: 

Name of first Plaintiff 

Address: 

ddress: 

elephone No: 

appeal. 

Identify and explain. 

  1

  _

         

         

 

      3

 

        4

 

   

    T

  A

  T

5.  Identify all the lower court hearings. 

Type of proceeding (i.e. motion, trial, etc.) 

Date(s) Occurred 

Court Reporter 

 

 

 

6.  Nature of case: 

a.  If the lower court case number provided on page 1 does not include a suffix, please specify the 

circuit court case code (i.e. NI, CK, etc):  ______________________________. 

b.  Identify the procedural nature of the case being appealed. 

    arbitration 
     interlocutory matter 
    administrative proceeding (specify agency) _______________________________________ 
    other (i.e. default judgment)____________________________________________________ 

   post-judgment action 
   summary disposition 

    bench trial 
    jury trial 

  declaratory judgment 

.  Briefly describe the nature of the action and the result in the trial court.  Conclusory statements 

such as "the judgment of the trial court is not supported by law" are unacceptable.  Attach 
additional pages as needed. 

8.  Briefly state the issues to be raised in this appeal.  Attach additional pages as needed. 

9.  The amount and terms of the judgment appealed are:  

0.  Settlement negotiations.  (Check all boxes that apply.) 

    Settlement negotiations have been conducted or are scheduled. 
    Settlement is unlikely. 
    Other ______________________________________________________________________________ 

________________ 
Date 

_________________________________ 
Signature 

Provide the Proof of Service on a separate form. 

2 

  

  

  

 

 

 

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  1