800-00006 -Docketing Statement (01/2018) Page 1 of 2
Vermont Supreme Court
109 State Street
Montpelier, VT 05609-0801
802-828-4774
www.vermontjudiciary.org
DOCKETING STATEMENT
Vermont Rule of Appellate Procedure (V.R.A.P.) 3(e)
Supreme Court Docket No. (if known): __________________________________________________
Case Name: __________________________________________________
Filed by or on behalf of: __________________________________________________
(party name)
Choose One: Appellant
Appellee
Appellee need not complete Sections A or B unless Appellee disagrees with Appellant’s answers.
A. Original Court/Board Information
1. Court/Board Name: ____________________________________________
2. Court/Board Docket No.: ____________________________________________
3. Judge Name (if applicable): ____________________________________________
4. Date of Decision Being Appealed: ____________________________________________
5. Date Notice of Appeal Filed: ____________________________________________
B. Brief Description of Case. (Separate sheet may be attached)
C. Statement of Issues to be Raised on Appeal. (Separate sheet may be attached)
D. Is the decision being appealed a written order? Yes No
(If yes, please attach)
800-00006 -Docketing Statement (01/2018) Page 2 of 2
E. Transcripts
Are transcripts necessary for the appeal? Yes No
If yes, have you ordered transcripts? Yes No
If ordered, attach a copy of the receipt from the transcription company.
If you have already ordered and received transcripts that you want to include in the record on appeal,
you must list those hearing dates below and arrange to have the transcription service transmit the
transcript to the Court.
__________________________________________________________________________________
__________________________________________________________________________________
For Appellee Only:
Do you agree as to which transcript(s) are necessary for the appeal? Yes No
If not, see V.R.A.P. 10(b)(5).
F. Expedited Resolution
Is this matter appropriate for expedited disposition by a three-Justice panel? Yes No
See criteria in V.R.A.P. 33.2(b).
Please Explain. (Separate sheet may be attached)
Signature: _______________________________________________ Date: _______________________
Name:
Mailing address:
Phone:
Email address:
Attorney for: