§ Form No. 16 Designation of record for appeals from tribunals other than district courts

Form No. 16. Designation of record for appeals from tribunals other than district courts

    BEFORE THE (NAME OF TRIBUNAL) OF THE STATE OF OKLAHOMA

    ___________________________________,                       )

    )

    Petitioner, Plaintiff, Protestant                                          )

    )

                                                                    )                              Cause No. __________.

    v.                                                                                   )

    )

    )
   

    ___________________________________,                        )

      )

    Respondent, Defendant, etc.                                              )

    DESIGNATION OF RECORD FOR APPEALS FROM TRIBUNALS OTHER THAN DISTRICT COURTS

    ___ Designation of Record

    ___ Counter-Designation of Record

    ___ Amended Designation of Record

    A. DESIGNATION OF RECORD AND TRANSCRIPTS

    [Plaintiff, Protestant, Petitioner, etc., or Defendant, Respondent, etc.] _______ hereby designates the following for inclusion in the record on appeal in this case:

    B. DATE, SIGNATURE, AND SERVICE BY COUNSEL OR PARTY

    DATE: _______________, 19___.

    Signature: ___________________________________________

    (Signature of Attorney or Pro Se Party)

    Attorney for ___________________________________________

    (Petitioner, etc., or Respondent, etc.)

    OBA No.: ___________________________________________

    Firm: ___________________________________________

    Address: ___________________________________________

    ___________________________________________

    ___________________________________________

    Telephone: ___________________________________________

    CERTIFICATE OF SERVICE

    I, _______ , hereby certify that in addition to filing the original Designation of Record with the _______ a copy of the foregoing Designation of Record was mailed by first class mail, postage prepaid, this ___ day of _______ 199___, to the following:

    [Names and Addresses of all parties or their counsel of record]

    ________________________________________________________________________________

    Adopted July 10, 1996

    Effective January 1, 1997

    Heading renumbered by order of May 5, 2005, which added a new Part IX.