O:\lasc\rules\filings0.wpd Revised 12-9-98
SUPREME COURT OF LOUISIANA
WRIT APPLICATION FILING SHEET
NO.___________________________________
TO BE COMPLETED BY COUNSEL or PRO SE LITIGANT FILING APPLICATION
TITLE
Applicant:_______________________________________
Have there been any other filings in this
______________________________________ Court in this matter? G Yes G No
VS.
Are you seeking a Stay Order?_____
Priority Treatment?_____
______________________________________ If so you MUST complete & attach a Priority Form
LEAD COUNSEL/PRO SE LITIGANT INFORMATION
APPLICANT: RESPONDENT:
Name:_________________________________________ Name:__________________________________________
Address:_______________________________________ Address:________________________________________
________________________________________ ________________________________________
PhoneNo._______________ Bar Roll No.____________ PhoneNo._______________ Bar Roll No.____________
Pleading being filed: G In proper person, G In Forma Pauperis
Attach a list of additional counsel/pro se litigants, their addresses, phone numbers and the parties they represent.
TYPE OF PLEADING
G Civil, G Criminal, R.S. 46:1844 protection, G Bar, G Civil Juvenile, G Criminal Juvenile, G Other
G CINC, G Termination, G Surrender, G Adoption, G Child Custody
ADMINISTRATIVE OR MUNICIPAL COURT INFORMATION
Tribunal/Court:_________________________________________ Docket No.________________________________
Judge/Commissioner/Hearing Officer:________________________________ Ruling Date:_____________________
DISTRICT COURT INFORMATION
Parish and Judicial District Court:____________________________________Docket Number:__________________
Judge and Section:______________________________________Date of Ruling/Judgment:_____________________
APPELLATE COURT INFORMATION
Circuit:__________ Docket No.__________________ Action:____________________________________________
Applicant in Appellate Court:_______________________________________________ Filing Date:________________
Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G
REHEARING INFORMATION
Applicant:_________________________________ Date Filed:___________ Action on Rehearing:_______________
Ruling Date:____________ Panel of Judges:________________________________________________ En Banc: G
PRESENT STATUS
G Pre-Trial, Hearing/Trial Scheduled date:_____________________________, G Trial in Progress, G Post Trial
Is there a stay now in effect?______ Has this pleading been filed simultaneously in any other court?______
If so, explain briefly_________________________________________________________________________________
_______________________________________________________________________________________________.
VERIFICATION
I certify that the above information and all of the information contained in this application is true and correct
to the best of my knowledge and that all relevant pleadings and rulings, as required by Supreme Court Rule X,
are attached to this filing. I further certify that a copy of this application has been mailed or delivered to the
appropriate court of appeal (if required), to the respondent judge in the case of a remedial writ, and to all other
counsel and unrepresented parties.
DATE SIGNATURE
