Appendix C. CIVIL WRIT APPLICATION FILING SHEET

APPENDIX C.

SUPREME COURT OF LOUISIANA

CIVIL

WRIT APPLICATION FILING SHEET

TO BE COMPLETED BY COUNSEL OR PRO SE LITIGANT FILING APPLICATION

CASE TITLE: _________________________________________________________________________

APPLICANT PARTY NAME(S):__________________________________________________________

Have there been any other filings in this Court in this matter: □ YES □ NO

Are you seeking a Stay Order? □ YES □ NO. If so, you MUST complete a civil priority form.

Are you seeking Priority Treatment? □ YES □ NO. If so, you MUST complete a civil priority form.

Does this pleading contain confidential information? □ YES □ NO. If so, please file a motion to seal.

Does any pleading contain a constitutional challenge to any Louisiana codal or statutory provision? □ YES □ NO

If yes, which pleading? _______________________

If yes, has the Office of the Louisiana Attorney General been notified pursuant to La. R.S. 13:4448? □ YES □ NO

LEAD COUNSEL / PRO SE LITIGANT INFORMATION

APPLICANT:

Lead Counsel Name: ________________________________ Bar Roll No.___________________

Email address:______________________________________ Cell No.:______________________

RESPONDENT:

Lead Counsel Name: ________________________________ Bar Roll No.___________________

Email address:______________________________________ Cell No.:______________________

Is the pleading being filed: □ In proper person. □ In forma pauperis

Are there any pro se litigants involved in this matter: □ YES □ NO

TYPE OF PLEADING

□ Tort □ Contract □ Property □ Probate □ Family □ Juvenile □ Workers’ Comp

ead Counsel Name: ________________________________ Bar Roll No.___________________

Email address:______________________________________ Cell No.:______________________

Is the pleading being filed: □ In proper person. □ In forma pauperis

Are there any pro se litigants involved in this matter: □ YES □ NO

TYPE OF PLEADING

□ Tort □ Contract □ Property □ Probate □ Family □ Juvenile □ Workers’ Comp. □ Revenue (tax) □ Civil Other

□ Administrative Agency □ Bar Admission □ Lawyer Discipline □ Judicial Discipline □ Licensing / Discipline Other

LOWER COURT INFORMATION

Parish and Judicial District Court:_________________________________________ Docket No:______________

Judge and Section:___________________________________________ Date of Ruling:_____________________

APPELLATE COURT INFORMATION

Circuit:_________ Docket No.:__________ Applicant:_________________________ Filing date:_____________

Was this pleading simultaneously filed? □ YES □ NO.

Ruling date:_____________ Action:______________________________________________________________

Panel of Judges:_____________________________________________________________________ En Banc: □

REHEARING INFORMATION

Applicant:__________________________ Filing date:______________ Ruling date:________________________

Action:____________________________ Panel of Judges:___________________________________ En Banc: □

PRESENT STATUS

□ pre-trial

□ hearing; scheduled date:____________

□ trial; scheduled date:______________

□ trial in progress

Is there a stay now in effect: □ YES □ NO

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, to the lower court judge, and to all other counsel and

unrepresented parties

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, to the lower court judge, and to all other counsel and

unrepresented parties.

Date:____________________ Signature:_______________________________________________________ (Rev. 12/2022)