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FOURTEENTH COURT OF APPEALS
CIVIL APPEAL MEDIATION DOCKETING STATEME1*
FILED IN
RETURN WITHIN 15 DAYS TO: 14th COURT OF APPEALS
HOUSTON
CLERK, FOURTEENTH COURT OF APPEALS; MAR 12 2015
301 FANNIN, ROOM 245; HOUSTON, TEXAS 77002
***For Civil Appeals, see Section Vfor information about the Pro Bono Program slnSlS?ffrtJERK^
administered by the Pro Bono Committees of the Appellate Practice Sections of the StateTfotjtfa*«Jj^ -
the Houston Bar Association.
General Information:
Appellant(s): /
&fiiWL~ fc&b) Appellate Cause No.:
W„!S~-0*> 6S~cV
Trial Ct. Cause No.: fl&O 4
Appe.lee(s) #flW«Vr7*>*A*ot*'M*l -h** ^w^^??^
/
3. If you have not previously filed an affidavit of indigency and attached a file-stamped copy of that
affidavit, does yourincome exceed 200% of the U.S. Department of Health and Human Services Federal Poverty
Guidelines? These guidelines can be found in the Pro Bono Program Pamphlet as well as on the Internet at
http://aspe.hhs.gov/povertv/06po verty.shtm1. <
Yes D No i/
4. Areyou willing to disclose yourfinancial circumstances to thePro Bono Committee? If so, please attach
an Affidavit of Indigency completed and executed by the appellee. Forms may be found in the Clerk's Office or
on the Internet at http://www.tex-app.org and http://www.hba.orE/folder-seclions/sec-appellate.htm. Your
participation in the Pro Bono Pilot Program may be conditioned upon your execution of an affidavit under oath as
to your financial circumstances.
Yes No •
5. Give a brief description of the issues to be raised on appeal, the relief sought, and the applicable
standard of review, if known (withoutprejudice to the right to raise additional,issues or request additional relief;
use aseparate attachment, ifnecessary). VP tt&>* 8.m> W Lofc*™* Rmb i^i 77/tf jfotf/fln**
* / - ~- . Mt>rn. %*>$ 70^ flkitf p> ***AT
LHP /I pp&*&, rjz ctv*
VI. Alternative DisputeResolution/Mediation (if applicable)
Instructions: This information will be used in conjunction withthe Riile 32.1 docketing'statement to evaluate
your case for-possible referralto an alternative dispute resolution procedure. SeeTEX^R. APP. P. 32.1. The court
will riot consider youranswers if the case is submitted on the merits: Each party (except Where noted) must
complete and file a completed docketing form in the Courtof Appeals afterthe appearis perfected..
Check Y for yes or N for no. Fill in all blanks or check appropriate boxes.
1. Should this case be referred to mediation? Yes (5 No • (use additional sheets if necessary)
If no, why?
(The court makes the final decision regarding referral of a case to mediation)
/
2. Has this case been through an ADR procedure in the trial court? Yes • No 23
If you answered yes:
a. Who was the mediator?
b. What type of ADR procedure?
c. At what stage did the case go through ADR?
pre-trial trial post-trial other
3. Rate the case for complexity. Use^for the least complex and 5 for the most complex. Check one:
lO 2 • 3 0 4/D * 5 D
VII. Signature: X
Date: ttftkCtt {jO^hajl
Signature of counsel (or pro se party) State Bar No.:
Printed Name: : K-iVHfri M/rf-h.1
Address
Email Address
Telephone Number:
Facsimile Number:
Representing:' (Appellant/Appellee^