Form 6

No. ___________

[Insert Plaintiff’s Name] § IN THE DISTRICT COURT OF Plaintiff, §

§vs. § _________ COUNTY, TEXAS

§[Insert Defendant’s Name] §

Defendant. § _____ JUDICIAL DISTRICT

DESIGNATION OF ITEMS TO BE INCLUDED IN CLERK’S RECORD

TO: [Insert the Name, Title, and Address of the District Court Clerk, available on the District Clerk’s Website]

Under Texas Rule of Appellate Procedure 34.5, Plaintiff [insert plaintiff’s name] files this designation of items to be included in the Clerk’s Record in the appeal of the final judgment in the above case.

Request for Mandatory Items

[Insert party’s name] designates the following mandatory items specified in Texas Rule of Appellate Procedure 34.5 for inclusion in the sworn record:

1. all pleadings on which the summary judgment proceedings were held;2. the court’s docket sheet;3. the court’s order that is being appealed namely, the Final Judgment dated January 10,

2007;4. any post-order motions and the court’s orders thereon; 5. all notices of appeal; and6. all requests for preparation of the Clerk’s Record.

Request for Additional Items

In addition, [insert party’s name] designates the items listed below, all of which are specifically described to make them readily identifiable:

[insert filed date] Plaintiff’s Original Petition

[insert filed date] Defendant’s Original Answer

[insert filed date] [insert additional filed documents that were considered by the court or the jury in the final decision of the case]

[insert filed date] [insert final and appealable order in the case]

1

Form 6

Under Texas Rule of Appellate Procedure 37.3, Plaintiff [insert plaintiff’s name] will pay for the preparation of the Clerk’s Record.

Respectfully submitted,

_________________________________________Appellant’s NameAppellant’s Address

CERTIFICATE OF SERVICE

On [insert date], a copy of the foregoing instrument was served, in compliance with Texas Rules of Civil Procedure 21 and 21a, on the following in the manner listed below:

[Opposing Counsel’s Name] Via Regular Mail [or other acceptable method of service][FIRM][Address]Counsel for Appellee

_____________________________________ Counsel for Appellant’s Name

2