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) Appeal from County ) Circuit Number ) Trial Judge ) Date of Notice of Appeal ) Date of Judgment ) Date of Postjudgment Motion Order ) ) Supreme court rule which confers jurisdiction ) upon the reviewing court DOCKETING STATEMENT (Civil) 1.Is this a cross-appeal, separate appeal, joining in a prior appeal, or related to anotherappeal which is currently pending or which has been disposed of by this court? If so, state the docket number(s) of the other appeal(s): 2.If any party is a corporation or association, identify any affiliate, subsidiary, or parentgroup: 3.Full name and complete address of appellant(s) filing this statement: Name: Address: Telephone: E-mail address: *Use additional page if multiple appellants. American LegalNet, Inc. www.FormsWorkFlow.com Counsel on Appeal for appellant(s) filing this statement: Name: ARDC # Address: Telephone: E-mail address: *Use additional page if multiple appellants. 4.Full name and complete address of appellee(s): Name: Address : Telephone: E-mail address: *Use additional page if multiple appellees. Counsel on Appeal for appellee(s): Name: Address: Telephone: E-mail address: *Use additional page if multiple appellees. 5.Court reporting personnel: Name: Address: Telephone: E-mail address: *Use additional page if multiple court reporting personnel. 6.Is this appeal from a final order in a matter involving child custody or allocation ofparental responsibility or relocation of unemancipated minors pursuant to Illinois Supreme Court Rule 311(a), which requires Mandatory Accelerated Disposition of Child Custody, Allocation of Parental Responsibilities, and Relocation of Unemancipated Minors Appeals? Yes: No: *If yes, this docketing statement, briefs and all other notices, motions and pleadings filed byany party shall include the following statement in bold type on the top of the front page: American LegalNet, Inc. www.FormsWorkFlow.com THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER RULE 311(a). 7.State the general issues proposed to be raised (failure to include an issue in this statement will not result in the waiver of the issue on appeal): As attorney for the appellant self-represented appellant (check one), I hereby certify that on the day of , 20, I requested the clerk of the circuit court to prepare the record on appeal, and on the day of , 20, I requested the court reporting personnel to prepare the transcript(s). Date Appellant222s Attorney OR Appellant American LegalNet, Inc. www.FormsWorkFlow.com