App 003 Form PDF Details

Form 003 is a health care application used to collect and submit information about an individual's health. This application is required for those who wish to receive medical assistance in the state of Illinois. In order to complete Form 003, you will need to provide your name, date of birth, Social Security number, and other identifying information. You will also need to list all medical conditions for which you are seeking assistance. Be sure to double-check all information before submitting, as any errors may delay the processing of your application.

QuestionAnswer
Form NameApp 003 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other names2019 appellant form pdf, california app 003 form, notice record appeal, designating form

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APP-003

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

 

 

 

FOR COURT USE ONLY

NAME:

 

 

FIRM NAME:

 

 

STREET ADDRESS:

 

 

CITY:

STATE:

ZIP CODE:

TELEPHONE NO.:

FAX NO.:

 

E-MAIL ADDRESS:

 

 

ATTORNEY FOR (name):

 

 

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

 

STREET ADDRESS:

 

MAILING ADDRESS:

 

CITY AND ZIP CODE:

 

BRANCH NAME:

 

PLAINTIFF/PETITIONER:

 

DEFENDANT/RESPONDENT:

 

OTHER PARENT/PARTY:

 

APPELLANT'S NOTICE DESIGNATING RECORD ON APPEAL

SUPERIOR COURT CASE NUMBER:

 

(UNLIMITED CIVIL CASE)

 

RE: Appeal filed on (date):

COURT OF APPEAL CASE NUMBER (if known):

Notice: Please read Information on Appeal Procedures for Unlimited Civil Cases (form APP-001-INFO) before completing this form. This form must be filed in the superior court, not in the Court of Appeal.

1.RECORD OF THE DOCUMENTS FILED IN THE SUPERIOR COURT

I choose to use the following method of providing the Court of Appeal with a record of the documents filed in the superior court (check a, b, c, or d, and fill in any required information):

a.

(1)

A clerk's transcript under rule 8.122. (You must check (1) or (2) and fill out the clerk's transcript section (item 4) on pages 2 and 3 of this form.)

I will pay the superior court clerk for this transcript myself when I receive the clerk's estimate of the costs of this transcript. I understand that if I do not pay for this transcript, it will not be prepared and provided to the Court of Appeal.

(2)

(a)

(b)

I request that the clerk's transcript be provided to me at no cost because I cannot afford to pay this cost. I have submitted the following document with this notice designating the record (check (a) or (b)):

An order granting a waiver of court fees and costs under rules 3.50–3.58; or

An application for a waiver of court fees and costs under rules 3.50–3.58. (Use Request to Waive Court Fees (form FW-001) to prepare and file this application.)

b.

c.

An appendix under rule 8.124.

The original superior court file under rule 8.128. (NOTE: Local rules in the Court of Appeal, First, Third, and Fourth Appellate Districts, permit parties to stipulate (agree) to use the original superior court file instead of a clerk's transcript; you may select this option if your appeal is in one of these districts and all the parties have stipulated to use the original superior court file instead of a clerk's transcript in this case. Attach a copy of this stipulation.)

d.

An agreed statement under rule 8.134. (You must complete item 2b(2) below and attach to your agreed statement copies of all the documents that are required to be included in the clerk's transcript. These documents are listed in rule 8.134(a).)

2.RECORD OF ORAL PROCEEDINGS IN THE SUPERIOR COURT

I choose to proceed (you must check a or b below):

a.

WITHOUT a record of the oral proceedings (what was said at the hearing or trial) in the superior court. I understand that without a record of the oral proceedings in the superior court, the Court of Appeal will not be able to consider what was said during those proceedings in deciding whether an error was made in the superior court proceedings.

Page 1 of 4

Form Approved for Optional Use Judicial Council of California APP-003 [Rev. January 1, 2019]

APPELLANT'S NOTICE DESIGNATING RECORD ON APPEAL

(Unlimited Civil Case)

Cal. Rules of Court, rules 3.50, 8.121–8.124, 8.128, 8.130, 8.134, 8.137 www.courts.ca.gov

APP-003

CASE NAME:

SUPERIOR COURT CASE NUMBER:

2. b.

(1)

(2)

WITH the following record of the oral proceedings in the superior court (you must check (1), (2), or (3) below):

A reporter's transcript under rule 8.130. (You must fill out the reporter's transcript section (item 5) on pages 3 and 4 of this form.) I have (check all that apply):

(a)

 

 

Deposited with the superior court clerk the approximate cost of preparing the transcript by including the deposit

 

 

 

with this notice as provided in rule 8.130(b)(1).

 

 

 

 

(b)

 

 

Attached a copy of a Transcript Reimbursement Fund application filed under rule 8.130(c)(1).

 

 

 

 

(c)

 

 

Attached the reporter's written waiver of a deposit under rule 8.130(b)(3)(A) for (check either (i) or (ii)):

 

 

 

 

 

 

(i)

 

 

all of the designated proceedings.

 

 

 

 

 

(ii)

 

 

part of the designated proceedings.

 

Attached a certified transcript under rule 8.130(b)(3)(C).

(d)

 

An agreed statement. (Check and complete either (a) or (b) below.)

(a)

 

I have attached an agreed statement to this notice.

(b) All the parties have stipulated (agreed) in writing to try to agree on a statement. (You must attach a copy of this stipulation to this notice.) I understand that, within 40 days after I file the notice of appeal, I must file either the agreed statement or a notice indicating the parties were unable to agree on a statement and a new notice designating the record on appeal.

(3)

(a)

(b)

A settled statement under rule 8.137. (You must check (a), (b), or (c) below, and fill out the settled statement section (item 6) on page 4.)

The oral proceedings in the superior court were not reported by a court reporter.

The oral proceedings in the superior court were reported by a court reporter, but I have an order waiving fees and costs.

(c)

I am asking to use a settled statement for reasons other than those listed in (a) or (b). (You must serve and file the motion required under rule 8.137(b) at the same time that you file this form. You may use form APP-025 to prepare the motion.)

3.RECORD OF AN ADMINISTRATIVE PROCEEDING TO BE TRANSMITTED TO THE COURT OF APPEAL

I request that the clerk transmit to the Court of Appeal under rule 8.123 the record of the following administrative proceeding that was admitted into evidence, refused, or lodged in the superior court (give the title and date or dates of the administrative proceeding):

Title of Administrative Proceeding

Date or Dates

4.NOTICE DESIGNATING CLERK'S TRANSCRIPT

(You must complete this section if you checked item 1a above indicating that you choose to use a clerk's transcript as the record of the documents filed in the superior court.)

a.Required documents. The clerk will automatically include the following items in the clerk's transcript, but you must provide the date each document was filed, or if that is not available, the date the document was signed.

Document Title and Description

(1)Notice of appeal

(2)Notice designating record on appeal (this document)

(3)Judgment or order appealed from

(4)Notice of entry of judgment (if any)

(5)Notice of intention to move for new trial or motion to vacate the judgment, for judgment notwithstanding the verdict, or for reconsideration of an appealed order (if any)

(6)Ruling on one or more of the items listed in (5)

(7)Register of actions or docket (if any)

Date of Filing

APP-003 [Rev. January 1, 2019]

APPELLANT'S NOTICE DESIGNATING RECORD ON APPEAL

(Unlimited Civil Case)

Page 2 of 4

APP-003

CASE NAME:

SUPERIOR COURT CASE NUMBER:

4.NOTICE DESIGNATING CLERK'S TRANSCRIPT

b.Additional documents. (If you want any documents from the superior court proceeding in addition to the items listed in 4a. above to be included in the clerk's transcript, you must identify those documents here.)

I request that the clerk include in the transcript the following documents that were filed in the superior court proceeding. (You must identify each document you want included by its title and provide the date it was filed or, if that is not available, the date the document was signed.)

Document Title and Description

(8)

Date of Filing

(9)

(10)

(11)

See additional pages. (Check here if you need more space to list additional documents. List these documents on a separate page or pages labeled "Attachment 4b," and start with number (12).)

c.Exhibits to be included in clerk's transcript

I request that the clerk include in the transcript the following exhibits that were admitted in evidence, refused, or lodged in the superior court. (For each exhibit, give the exhibit number, such as Plaintiff's #1 or Defendant's A, and a brief description of the exhibit. Indicate whether or not the court admitted the exhibit into evidence. If the superior court has returned a designated exhibit to a party, the party in possession of the exhibit must deliver it to the superior court clerk within 10 days after service of this notice designating the record. (Rule 8.122(a)(3).))

Exhibit Number

(1)

Description

Admitted (Yes/No)

(2)

(3)

(4)

See additional pages. (Check here if you need more space to list additional exhibits. List these exhibits on a separate page or pages labeled "Attachment 4c," and start with number (5).)

5.NOTICE DESIGNATING REPORTER'S TRANSCRIPT

You must complete both a and b in this section if you checked item 2b(1) above indicating that you choose to use a reporter's transcript as the record of the oral proceedings in the superior court. Please remember that you must pay for the cost of preparing the reporter's transcript.

a.Format of the reporter's transcript

I request that the reporters provide (check one):

(1)

(2)

My copy of the reporter's transcript in electronic format.

My copy of the reporter's transcript in paper format.

(3)

My copy of the reporter's transcript in electronic format and a second copy in paper format.

(Code Civ. Proc., § 271.)

APP-003 [Rev. January 1, 2019]

APPELLANT'S NOTICE DESIGNATING RECORD ON APPEAL

(Unlimited Civil Case)

Page 3 of 4

APP-003

CASE NAME:

5.b. Proceedings

SUPERIOR COURT CASE NUMBER:

I request that the following proceedings in the superior court be included in the reporter's transcript. (You must identify each proceeding you want included by its date, the department in which it took place, a description of the proceedings (for example, the examination of jurors, motions before trial, the taking of testimony, or the giving of jury instructions), the name of the court reporter who recorded the proceedings (if known), and whether a certified transcript of the designated proceeding was previously prepared.)

Date

Department Full/Partial Day

Description

Reporter's Name

Prev. prepared?

(1)

Yes

No

(2)

Yes

No

(3)

Yes

No

(4)

Yes

No

See additional pages. (Check here if you need more space to list additional proceedings. List these exhibits on a separate page or pages labeled "Attachment 5b," and start with number (5).)

6.NOTICE DESIGNATING PROCEEDINGS TO BE INCLUDED IN SETTLED STATEMENT

(You must complete this section if you checked item 2b(3) above indicating you choose to use a settled statement.) I request that the following proceedings in the superior court be included in the settled statement. (You must identify each proceeding you want included by its date, the department in which it took place, a description of the proceedings (for example, the examination of jurors, motions before trial, the taking of testimony, or the giving of jury instructions), the name of the court reporter who recorded the proceedings (if known), and whether a certified transcript of the designated proceeding was previously prepared.)

Date

Department Full/Partial Day

Description

Reporter's Name

Prev. prepared?

(1)

Yes

No

(2)

Yes

No

(3)

Yes

No

(4)

Yes

No

See additional pages. (Check here if you need more space to list additional proceedings. List these proceedings on a separate page or pages labeled "Attachment 6," and start with number (5).)

7.a.

b.

Date:

The proceedings designated in 5b or 6

 

include

 

do not include

all of the testimony in the superior court.

If the designated proceedings DO NOT include all of the testimony, state the points that you intend to raise on appeal. (Rule 8.130(a)(2) and rule 8.137(d)(1) provide that your appeal will be limited to these points unless the Court of Appeal permits

otherwise.) Points are set forth:

 

Below

 

On a separate page labeled "Attachment 7."

(TYPE OR PRINT NAME)

(SIGNATURE OF APPELLANT OR ATTORNEY)

APP-003 [Rev. January 1, 2019]

APPELLANT'S NOTICE DESIGNATING RECORD ON APPEAL

 

 

 

(Unlimited Civil Case)

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Part number 1 of filling out app003

2. After filling out the previous part, go on to the subsequent step and fill out the necessary details in all these blanks - I choose to use the following, A clerks transcript under rule , I will pay the superior court, I request that the clerks, An order granting a waiver of, An application for a waiver of, An appendix under rule , The original superior court file, An agreed statement under rule , RECORD OF ORAL PROCEEDINGS IN THE, I choose to proceed you must check, and WITHOUT a record of the oral.

I request that the clerks, WITHOUT a record of the oral, and I choose to use the following of app003

3. This next step is all about CASE NAME, SUPERIOR COURT CASE NUMBER, APP, WITH the following record of the, A reporters transcript under rule , Deposited with the superior court, Attached a copy of a Transcript, Attached the reporters written, all of the designated proceedings, Attached a certified transcript, An agreed statement Check and, I have attached an agreed, All the parties have stipulated, A settled statement under rule , and The oral proceedings in the - fill in all these fields.

Part no. 3 for submitting app003

Many people frequently make some errors while filling in I have attached an agreed in this area. Ensure you reread what you type in here.

4. To move ahead, this next form section will require filling in several blanks. Examples of these are RECORD OF AN ADMINISTRATIVE, I request that the clerk transmit, Title of Administrative Proceeding, Date or Dates, NOTICE DESIGNATING CLERKS, Required documents The clerk will, Document Title and Description, Date of Filing, Notice of appeal, Notice designating record on, and Judgment or order appealed from, which you'll find integral to going forward with this form.

Part number 4 for submitting app003

5. To wrap up your document, this final segment features a couple of additional blanks. Typing in Judgment or order appealed from, Notice of entry of judgment if any, Notice of intention to move for, Ruling on one or more of the items, Register of actions or docket if, APP Rev January , APPELLANTS NOTICE DESIGNATING, Page of , and Unlimited Civil Case should wrap up everything and you're going to be done quickly!

Filling out section 5 of app003

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