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.