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)