In the Missouri Court of Appeals

IN THE MISSOURI COURT OF APPEALS EASTERN DISTRICT APPEAL NO. _ED CRIMINAL CASE INFORMATION FORM (This form must be filed with the Notice of Appeal with the Circuit Clerk)

List each party and the name of the attorney of record on appeal, if any, for each party. Attach additional sheets to identify all parties and attorneys if necessary.

Party Attorney STATE OF MISSOURI Name Bar No.

Address

City, State, Zip Code

Phone Number

v. Law Firm or Office

Name Bar No.

Address

Phone Number

Law Firm or Office ______

ATTACH A COPY OF THE JUDGMENT OR ORDER APPEALED.

A BRIEF STATEMENT OF THE CASE (Set forth charge(s) and sentence(s) imposed and summary of facts upon which conviction is based.)

Is this a Misdemeanor Felony or Municipal Conviction? Is the Defendant presently incarcerated? Yes No Has an Appeal Bond been filed? Yes No If Yes, Amount $

Name of Surety

Address of Surety

ATTACH COPY OF APPEAL BOND, IF ANY.

A COPY OF THIS FORM AND ATTACHMENTS MUST BE SERVED ON THE RESPONDENT.