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Petition for Review Form

The following is a template for use in preparing a petition for review to be filed with the Supreme Court of Texas. Please refer to the document “Preparing a Pro Se Petition for Review: Instructions for using Template” to help you in completing the following form. You may complete this form with information about your particular case.

You may use a total of fifteen pages to complete the “Statement of Facts, Summary of the Argument, Argument, and Prayer for Relief” sections of the petition. This form sets each of these sections out on separate pages. Please use additional sheets as necessary.

No.__________________

In the

Supreme Court of Texas

___________________________________________________,

Petitioner,

v.

___________________________________________________,

Respondent.

From the _______ Court of Appeals, Cause No.__________________,

and the _________________ Court for ___________________ County,

Cause No. __________________, Honorable __________________________

Petition for Review

Petitioner’s Name:

Petitioner’s Address:

Petitioner’s Telephone:

Petitioner’s Fax:

Petitioner’s e-mail:

IDENTITY OF PARTIES AND COUNSEL

The following constitutes a list of all parties to the trial court's final judgment and the names and addresses of all trial and appellate counsel:

|Petitioner’s name | |

|Petitioner's trial counsel’s name, address, | |

|telephone and fax (if applicable) | |

| | |

| | |

| | |

| | |

|Petitioner's appellate counsel’s name, | |

|address, telephone and fax (if applicable) | |

| | |

| | |

| | |

| | |

| | |

|Respondent’s name | |

|Respondent's trial counsel’s name, address, | |

|telephone and fax (if applicable) | |

| | |

| | |

| | |

| | |

|Respondent's appellate counsel’s name, | |

|address, telephone and fax (if applicable) | |

| | |

| | |

| | |

| | |

(use additional pages if necessary)

Page i

IDENTITY OF PARTIES AND COUNSEL

(contined)

|Other parties’ names, addresses, | |

|telephone and fax (if applicable) | |

| | |

| | |

| | |

| | |

|Counsel for other parties’ names, | |

|addresses, telephone and fax (if | |

|applicable) | |

| | |

| | |

| | |

| |(use additional pages if necessary) |

TABLE OF CONTENTS

Page

IDENTITY OF PARTIES AND COUNSEL ___

INDEX OF AUTHORITIES ___

STATEMENT OF THE CASE ___

STATEMENT OF JURISDICTION ___

ISSUES PRESENTED ___

STATEMENT OF FACTS ___

SUMMARY OF THE ARGUMENT ___

ARGUMENT AND AUTHORITIES ___

PRAYER FOR RELIEF ___

APPENDIX ___

Page ii

INDEX OF AUTHORITIES

Cases, statutes and other authorities Page

(use additional pages if necessary)

Page iii

STATEMENT OF THE CASE

Nature of the Case

Trial Court Information

Trial Court Judge:

Trial court name/number:

Trial court county:

Trial court ruling:

Court of Appeals Information

Parties in the Court of Appeals

All Appellants:

All Appellees:

Other parties:

Information about the Court of Appeals

Court of Appeals Number:

Justices deciding appeal:

Author of court’s opinion:

Author of any separate opinion:

Citation of opinion, if published:

Ruling of Court of Appeals:

Motions for Rehearing

Was a motion for rehearing filed?

If filed, how did Court rule?

Was a motion for reconsideration en banc filed?

If filed, how did Court rule?

(use additional sheets if necessary)

Page iv

STATEMENT OF JURISDICTION

The Supreme Court has jurisdiction pursuant to the following subsection(s) of Texas Government Code section 22.001(a): (circle the subsection(s) that apply):

|(1) (disagreement among justices of court of |(2) (conflict between holding of court of |(3) (construction or validity of a statute) |

|appeals on question of law material to |appeals and another court on question of | |

|decision) |law) | |

|(4) (a matter involving state revenue) |(5) (a case in which the railroad |(6) (an error of law has been committed of |

| |commission is a party) |importance to the jurisprudence of the state) |

ISSUES PRESENTED

(use additional sheets as necessary)

Page iv

STATEMENT OF FACTS

(use additional sheets as necessary)

Page 1

SUMMARY OF THE ARGUMENT

(use additional sheets as necessary)

Page 2

ARGUMENT AND AUTHORITIES

(use additional sheets as necessary)

Page 3

PRAYER FOR RELIEF

(use additional sheets as necessary)

Page 4

Respectfully submitted,

Signature of pro se party

CERTIFICATE OF SERVICE

I certify that a copy of this Petition for Review was served on Respondent ______________ by U.S. Mail on the following date: _________.

Signature of pro se party

APPENDIX

TAB

1 Judgment or order challenged on appeal

2 Opinion of Court of Appeals

3. Judgment of Court of Appeals

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