/£/$. 00 /&> ?-A/ FOURTEENTH COURT OF APPEALS CIVIL APPEAL MEDIATION DOCKETING STATEME1* FILED IN RETURN WITHIN 15 DAYS TO: 14th COURT OF APPEALS HOUSTON CLERK, FOURTEENTH COURT OF APPEALS; MAR 12 2015 301 FANNIN, ROOM 245; HOUSTON, TEXAS 77002 ***For Civil Appeals, see Section Vfor information about the Pro Bono Program slnSlS?ffrtJERK^ administered by the Pro Bono Committees of the Appellate Practice Sections of the StateTfotjtfa*«Jj^ - the Houston Bar Association. General Information: Appellant(s): / &fiiWL~ fc&b) Appellate Cause No.: W„!S~-0*> 6S~cV Trial Ct. Cause No.: fl&O 4 Appe.lee(s) #flW«V r7*>*A*ot*'M*l -h** ^w"??^ / 3. If you have not previously filed an affidavit of indigency and attached a file-stamped copy of that affidavit, does yourincome exceed 200% of the U.S. Department of Health and Human Services Federal Poverty Guidelines? These guidelines can be found in the Pro Bono Program Pamphlet as well as on the Internet at http://aspe.hhs.gov/povertv/06po verty.shtm1. * 8.m> W Lofc*™* Rmb i^i 77/tf jfotf/fln** * / - ~- . Mt>rn. %*>$ 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^