APP-004 - Civil Case Information Statement (Appellate)

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Civil Case Information Statement (Appellate)

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Form ID: APP-004
Title: Civil Case Information Statement (Appellate)
Effective Date: 2025-01-01
Mandatory Form: yes
Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-004
Primary Download URL: https://www.courts.ca.gov/documents/app004.pdf
Form Detail Page:
Civil Case Information Statement (Appellate)
(APP-004)
Give the Court of Appeal information about your appeal. A copy of the trial court decision (judgment or order) you are appealing is always attached to this form.
Get form APP-004
Effective: January 1, 2025
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PDF Text:
Form Adopted for Mandatory Use 
Judicial Council of California 
APP-004 [Rev. January 1, 2025]
 CIVIL CASE INFORMATION STATEMENT 
(Appellate)
TO BE FILED IN THE COURT OF APPEAL APP-004
COURT OF APPEAL CASE NUMBER (if known):
FOR COURT USE ONLY
SUPERIOR COURT CASE NUMBER:
COURT OF APPEAL, APPELLATE DISTRICT, DIVISION 
ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
ATTORNEY FOR (name):
APPELLANT:
RESPONDENT:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
JUDGES (all who 
participated in case):
CIVIL CASE INFORMATION STATEMENT
NOTE TO APPELLANT: You must file this form with the clerk of the Court of Appeal within 15 days after the Court of Appeal 
assigns the appeal a case number. You must attach to this form a copy of the judgment or order being appealed that shows 
the date it was entered (see Cal. Rules of Court, rule 8.104 for definition of "entered"). A copy of this form must also be 
served on the other party or parties to this appeal. (CAUTION: An appeal in a limited civil case (Code Civ. Proc., § 85) may be 
taken ONLY to the appellate division of the superior court (Code Civ. Proc., § 904.2) or to the superior court (Code Civ. Proc., 
§ 116.710 [small claims cases]).
PART I – APPEAL INFORMATION1. APPEALABILITY 
a. Appeal is from:
judgment after jury trial.
judgment after court trial.
default judgment.
judgment after an order granting a summary judgment motion.
judgment of dismissal under Code Civ. Proc., § 581d, 583.250, 583.360, or 583.430.
judgment of dismissal after an order sustaining a demurrer.
an order after judgment under Code Civ. Proc., § 904.1(a)(2).
an order or judgment under Code Civ. Proc., § 904.1(a)(3)–(13).
Other (describe and specify code section that authorizes this appeal):
b. Does the judgment appealed from dispose of all causes of action, including all cross-actions between the parties?      
Yes No (If no, please explain why the judgment is appealable):
2. TIMELINESS OF APPEAL (Provide all applicable dates.)
a. Date of entry of judgment or order appealed from:  
b. Date that notice of entry of judgment or a copy of the judgment was served by the clerk or by a party under California Rules of 
Court, rule 8.104:  
c. Was a motion for new trial, for judgment notwithstanding the verdict, for reconsideration, or to vacate the judgment made and     
denied?
Yes No (If yes, please specify the type of motion):
Date notice of intention to move for new trial (if any) filed:
Date motion filed: Date motion denied: Date denial served: 
d. Date notice of       appeal or cross-appeal  filed:  
3. BANKRUPTCY OR OTHER STAY
Is there a related bankruptcy case or a court-ordered stay that affects this appeal? 
(If yes, please attach a copy of the bankruptcy petition [without attachments] and 
any stay order.)
Yes No
Page 1 of 4

APP-004 [Rev. January 1, 2025]  CIVIL CASE INFORMATION STATEMENT 
(Appellate)
APP-004
APPELLATE CASE TITLE: APPELLATE COURT CASE NUMBER:
4. APPELLATE CASE HISTORY (Provide additional information, if necessary, on attachment 4.) Is there now, or has there previously 
been, any appeal, writ, or other proceeding related to this case pending in any California appellate court?
Yes No (If yes, insert name of appellate court):
Appellate court case no.: Title of case: 
Name of trial court: Trial court case no.: 
5. SERVICE REQUIREMENTS
Is service of documents in this matter, including a notice of appeal, petition, or brief, required on the Attorney General or other  
nonparty public officer or agency under California Rules of Court, rule 8.29 or a statute?
Yes No (If yes, please  indicate the rule or statute that applies)
Rule 8.29 (e.g., constitutional challenge; state or county party)
Bus. & Prof. Code, §16750.2 (Antitrust)
Bus. & Prof. Code, § 17209 (Unfair Competition Act)
Bus. & Prof. Code, § 17536.5 (False advertising)
Civ. Code, § 51.1 (Unruh, Ralph, or Bane Civil Rights  
Acts; antiboycott cause of action; sexual harassment in 
business or professional relations; civil rights action by 
district attorney)
Civ. Code, § 55.2 (Disabled access to public  
conveyances, accommodations, and housing)
Code Civ. Proc., § 1355 (Escheat)
Gov. Code, § 946.6(d) (Actions against public entities)
Gov. Code, § 4461 (Disabled access to public buildings)
Gov. Code, § 12656(a) (False Claims Act)
Health & Saf. Code, § 19954.5 (Accessible seating and  
accommodations)
Health & Saf. Code, § 19959.5 (Disabled access to  
privately funded public accommodations)
Pub. Resources Code, § 21167.7 (CEQA)
Other (specify statute):
NOTE: The rule and statutory provisions listed above require service of a copy of a party's notice of appeal, petition, or brief 
on the Attorney General or other public officer or agency. Other statutes requiring service on the Attorney General or other  
public officers or agencies may also apply. 
PART lI – NATURE OF ACTION
1. Nature of action (check all that apply):
a. Conservatorship
b. Contract
c. Eminent domain
d. Equitable action (1) Declaratory relief (2) Other (describe):
e. Family law
f. Guardianship
g. Probate
h. Real property rights (1) Title of real property (2) Other (describe):
i. Tort
(1) Medical malpractice (2) Product liability
(3) Other personal injury (4) Personal property
(5) Other tort (describe):
j. Trust proceedings
k. Writ proceedings in superior court
(1) Mandate (Code Civ. Proc., § 1085) (2) Administrative mandate (Code Civ. Proc., § 1094.5)
(3) Prohibition (Code Civ. Proc., § 1102) (4) Other (describe):
l. Other action (describe):
2. This appeal is eligible for calendar preference/priority on appeal (cite authority or explain):
A party seeking calendar preference or priority on a non-statutory or discretionary ground must promptly serve and file in the Court 
of Appeal a motion for preference. (See Cal. Rules of Court, rule 8.240).
Page 2 of 4

APP-004 [Rev. January 1, 2025]  CIVIL CASE INFORMATION STATEMENT 
(Appellate)
APP-004
APPELLATE CASE TITLE: APPELLATE COURT CASE NUMBER:
PART  III – PARTY AND ATTORNEY  INFORMATION 
In the spaces below or on a separate page or pages, list all the parties and all their attorneys of record who will participate in the 
appeal. For each party, provide all of the information requested on the left side of the page. On the right side of the page, if a party is 
self-represented please check the appropriate box and provide the party's mailing address, telephone number, fax number, and email 
address. If a party is represented by an attorney, on the right side of the page, check the appropriate box and provide all of the 
requested information about that party's attorney.
Responses to Part III are attached instead of below
Name of Party:
Appellate court designation:
Appellant Respondent
Trial court designation:
Plaintiff Defendant
Other (specify):
Represented by attorney Self-represented
Name of attorney:
State Bar no:
Firm name:
Mailing address:
Telephone no.: Fax no:
Email address:
Name of Party:
Appellate court designation:
Appellant Respondent
Trial court designation:
Plaintiff Defendant
Other (specify):
Represented by attorney Self-represented
Name of attorney:
State Bar no:
Firm name:
Mailing address:
Telephone no.: Fax no:
Email address:
Name of Party:
Appellate court designation:
Appellant Respondent
Trial court designation:
Plaintiff Defendant
Other (specify):
Represented by attorney Self-represented
Name of attorney:
State Bar no:
Firm name:
Mailing address:
Telephone no.: Fax no:
Email address:
Name of Party:
Appellate court designation:
Appellant Respondent
Trial court designation:
Plaintiff Defendant
Other (specify):
Represented by attorney Self-represented
Name of attorney:
State Bar no:
Firm name:
Mailing address:
Telephone no.: Fax no:
Email address:
Additional pages attached
Date: 
This statement is prepared and submitted by:     
(SIGNATURE OF ATTORNEY OR SELF-REPRESENTED PARTY)
Page 3 of 4

APP-004 [Rev. January 1, 2025]  CIVIL CASE INFORMATION STATEMENT 
(Appellate)
APP-004
APPELLATE CASE TITLE: APPELLATE COURT CASE NUMBER:
NOTICE TO PARTIES: A copy of this form must be served on the other party or parties to this appeal. If served by mail or personal 
delivery, THE MAILING OR DELIVERY MUST BE PERFORMED BY SOMEONE WHO IS NOT A PARTY TO THE APPEAL. 
Electronic service is authorized only if ordered by the court or if the party served has agreed to accept electronic service. A person 
who is at least 18 years old must complete the information below and serve all pages of this document. When all pages of this 
document have been completed and a copy served, the original may then be filed with the court.
PROOF OF SERVICE
Mail  Personal Service Electronic Service
1. At the time of service I was at least 18 years of age.
2. My residence or business address is (specify):
3. I mailed, personally delivered, or electronically served a copy of the Civil Case Information Statement (Appellate) as follows 
(complete a, b, or c):
a.            Mail. I am a resident of or employed in the county where the mailing occurred and am not a party to this legal action.
(1) I enclosed a copy in an envelope and
(a)   deposited the sealed envelope with the United States Postal Service, with the postage fully prepaid.
(b)            placed the envelope for collection and mailing on the date and at the place shown in items below, following our 
ordinary business practices. I am readily familiar with this business's practice for collecting and processing 
correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is 
deposited in the ordinary course of business with the United States Postal Service, in a sealed envelope with 
postage fully prepaid.  
(2) The envelope was addressed and mailed as follows:
(a)   Name of person served:
(b)            Address on envelope:
(c)    Date of mailing:
(d)            Place of mailing (city and state):
b.            Personal delivery. I am not a party to this legal action. I personally delivered a copy as follows:
(1) Name of person served:
(2) Address where delivered:
(3) Date delivered:
(4) Time delivered:
c. Electronic service. My electronic service address is (specify):
I electronically served a copy as follows:
(1) Name of person served:
(2) Electronic service address of person served:
(3) On (date):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
 (SIGNATURE OF DECLARANT)
Page 4 of 4

Retrieval chunks

• #1

  Form ID: APP-004 Title: Civil Case Information Statement (Appellate) Effective Date: 2025-01-01 Mandatory Form: yes Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-004 Primary Download URL: https://www.courts.ca.gov/documents/app004.pdf Form Detail Page: Civil Case Information Statement (Appellate) (APP…

• #2

  Other (describe and specify code section that authorizes this appeal): b. Does the judgment appealed from dispose of all causes of action, including all cross-actions between the parties? Yes No (If no, please explain why the judgment is appealable): 2. TIMELINESS OF APPEAL (Provide all applicable dates.) a. Date …

• #3

  Gov. Code, § 946.6(d) (Actions against public entities) Gov. Code, § 4461 (Disabled access to public buildings) Gov. Code, § 12656(a) (False Claims Act) Health & Saf. Code, § 19954.5 (Accessible seating and accommodations) Health & Saf. Code, § 19959.5 (Disabled access to privately funded public accommodations) …

• #4

  Responses to Part III are attached instead of below Name of Party: Appellate court designation: Appellant Respondent Trial court designation: Plaintiff Defendant Other (specify): Represented by attorney Self-represented Name of attorney: State Bar no: Firm name: Mailing address: Telephone no.: Fax no: Ema…

• #5

  (1) I enclosed a copy in an envelope and (a) deposited the sealed envelope with the United States Postal Service, with the postage fully prepaid. (b) placed the envelope for collection and mailing on the date and at the place shown in items below, following our ordinary business practices. I am readily…