MASSACHUSETTS APPEALS COURT
John Adams Courthouse
One Pemberton Square, Suite 1200
Boston, MA 02108
(617) 725-8106
http://www.mass.gov/courts/appealscourt/
CIVIL DOCKETING STATEMENT
INSTRUCTIONS
Each appellant or cross-appellant, other than a self-represented litigant who is incarcerated, is required to submit the
attached docketing statement within fourteen days of issuance of the notice of entry of the appeal.
All attorneys must electronically file the docketing statement using eFileMA.com in non-impounded cases.
Attorneys filing in impounded cases and self-represented parties in all cases are encouraged, but not required, to file
the docketing statement using eFileMA.com. Filers may request waiver of the eFileMA.com convenience fee when
e-filing a docketing statement by using a waiver account. Docketing statements that are not e-filed must be submitted
on paper by mail or hand-delivery to the Appeals Court.
All fields and the certificate of service must be completed. If a request for information is inapplicable to your case,
please enter "N/A." If inadequate space is provided for the information requested, please provide the additional
information in an attachment. Incomplete docketing statements will not be accepted for filing.
The docketing statement and certificate of service may be signed electronically by the person filing the docketing
statement. The proper format for an electronic signature is "/s/" followed by the name of the filer, e.g., "/s/ Jason
Jones." Upon agreement between the parties, service of the docketing statement by electronic mail will be deemed in
compliance with Mass.R.A.P. 13(c).
To the extent that any request for information on the docketing statement is not clear, please refer to the instructions
for each section.
Section 1. Please provide the name or names of each appellant or cross-appellant on whose behalf this docketing
statement is submitted.
Section 2. If the docketing statement is being submitted by an attorney, please enter the attorney's name and Board
of Bar Overseers registration number. If the docketing statement is being submitted by a self-represented litigant,
please check the box on the second line and provide the self-represented litigant's name in the space provided.
Section 3. Please provide the lower court department and division, (e.g. Chelsea District Court) on the line at
subsection (a). Please provide the lower court docket number(s) on the line at subsection (b). For subsection (c),
please list each judge whose order or judgment is the subject of the appeal and the judge's role in the proceedings. If
a judge ruled on a motion, but you are not appealing that ruling, the judge need not be listed. In subsection (d),
please provide information concerning any statute or court order deeming the case or any part thereof impounded.
For the purposes of this form, the term "impounded" includes any portion of the record that is impounded, sealed,
deemed confidential, or excluded from public access by statute, court order, rule, or standing order.
Section 4. From the dropdown menu, please select the case nature that most closely describes the case being
appealed.
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Section 5. Please provide the requested information pertaining to the perfection of the appeal. In subsection (a),
please answer whether the appeal is from a final judgment or whether it is an appeal from an interlocutory order.
In subsection (b), if it is an appeal from an interlocutory order, please specify the statute or rule that permits an
interlocutory appeal, e.g., G.L. c. 231, s. 118, 1st para. or doctrine of present execution. In subsection (c) please
provide the date that the judgment or order from which you are appealing was entered on the docket of the lower
court. Please note that this date may be different than the date listed on the order or judgment. In subsection (d),
please enter the date that the notice of appeal was filed in the lower court. In subsection (e), if the appeal is from a
final judgment, please indicate whether any of the listed post-judgment motions were filed and if so, provide the
date of service and not the date filed.
Section 6. Please list the appellate issues that you anticipate raising. If the interpretation of a particular statute or
regulation is necessary to resolve the appeal, please provide an appropriate citation to the statute or regulation.
Failure to list an appellate issue in the docketing statement will not result in waiver of that issue. This is for
informational purposes only and is not an appropriate place for argument.
Section 7. Please identify any related appeals. Appeals may be related because they either involve the same parties
or raise the same issue(s). For appeals that involve the same parties, please list all past, present, and anticipated
appeals. For appeals that raise the same issue(s), please only list pending or anticipated appeals.
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MASSACHUSETTS APPEALS COURT
CIVIL DOCKETING STATEMENT
Appeals Court Docket Number
Plaintiff(s):
1. Party Information
Name of the appellant(s) or cross-appellant(s) on whose behalf this statement is being filed:
2. Attorney Information
Name
BBO#
3. Lower Court, Board or Agency Information
b. Lower Court Docket Number(s)
Caption used in the lower court
v.
Defendant(s):
c. Specify the name and the role of each judge whose orders are at issue on appeal [not applicable for appeals directly from a board or
agency]:
Judge, first and last name
Role
Role
Role
Judge, first and last name
Judge, first and last name
In addition to providing the information below, parties filing a brief or record appendix that contains impounded materials must comply
with Uniform Rule on Impoundment Procedure Rule 12(c), Supreme Judicial Court Rule 1:15 s. 2(c), and M.R.A.P. 16(d), 16(m), 18(a),
and 18(g). If this case or any material therein is impounded, specify which documents are impounded and the authority for
impoundment, e.g. court order, statute:
and provide your name
Or, check this box if you are self-represented
d. Was the case or any information in the record designated as impounded in the lower court? (see Section 3)
Yes
No
a. Court Department
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-P-
Select the most appropriate description, or enter description:
5. Perfection of Appeal
a. Is the appeal from a final judgment, i.e., judgment disposing of all parties and claims?
Yes No
b. If no, identify the basis on which the interlocutory order is immediately appealable.
c. Docketing Date of Judgment or Interlocutory Order Appealed
d. Date Notice of Appeal Filed
Type of Motion Check if filed Date Served (not date filed)
Motion for Judgment (Rule 50(b))
Notwithstanding the Verdict
Motion to Amend or Make Additional
Findings (Rule 52(b))
Motion to Alter or Amend Judgment
(Rule 59)
Motion for Relief from Judgment (Rule 60)
Other (specify)
Yes No
NoYes
Yes No
NoYes
Yes No
In cases other than child welfare appeals, please provide a short statement of the anticipated issues on appeal. If the appellate issue
involves the interpretation of a particular statute or regulation, please provide a citation to that statute or regulation. (Note: This
statement is for informational purposes only and failure to raise an issue here will not preclude an appellant from raising the issue in its
brief.):
6. Appellate Issues
4. Nature of the Case
If you answered yes to either question, provide the case name and docket number and describe below the related matter or issue:
7. Related Appeals
Are there any pending, past, or anticipated future appeals or original appellate proceedings that involve these parties or this
case which have been entered in the Appeals Court or Supreme Judicial Court?
Do you know of any pending or anticipated appeals raising related issues?
NoYes
NoYes
Please provide information regarding the following post-judgment motions that may affect the timeliness of the notice of the appeal.
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CERTIFICATE OF SERVICE
Pursuant to Mass.R.A.P. 13(d), I hereby certify, under the penalties of perjury, that on this date of
I have made service of a copy of the Massachusetts Appeals Court Docketing Statement filed on behalf of
, upon the attorney of record for each party, or if the party
has no attorney then I made service directly to the self-represented party, by
to the following person(s) and at the following address(es). Note: Service may be made by e-mail only with the consent of
each party or opposing counsel:
hand delivery first class mail e-mail
Address
Telephone
Signature
Respectfully Submitted,
Signature
Address
BBO Number
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