Please Insert Additional Pages As Necessary to Complete Each Section

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 assist you in completing the following form. You will need to complete the sections of the form shaded gray with information about your particular case.

Please insert additional pages as necessary to complete each section.

SAMPLE TABLE OF CONTENTS

Page

IDENTITY OF PARTIES AND COUNSEL __

INDEX OF AUTHORITIES __

STATEMENT OF THE CASE __

STATEMENT OF JURISDICTION __

ISSUES PRESENTED __

[Identify the subject matter of each issue or point] __

STATEMENT OF FACTS __

SUMMARY OF THE ARGUMENT __

ARGUMENT AND AUTHORITIES __

[Identify any headings used in the brief to organize you argument] __

PRAYER FOR RELIEF __

APPENDIX __

SAMPLE INDEX OF AUTHORITIES

Cases Page

[list all authorities cited in your brief, in the following format]

Doe v. Roe,

333 S.W.4d 111 (Tex. App.—Dallas, 2010, pet. denied) __

Plaintiff v. Defendant,

111 S.W.4d 333 (Tex. App.—Austin, 2010, pet. denied) __

Statutes and other authorities

[list all authorities cited in your brief, in the following format]

Tex. Gov’t Code Ann. § 22.001(a)(6) __

Tex. R. App. P. 53 __

No. [insert Case No. if one has been assigned]

In the Supreme Court of Texas

[name of Petitioner[s]],

Petitioner[s],

v.

[name of Respondent[s]],

Respondent[s].

From the ______Court of Appeals, Cause No. ______,

and the ______Court for ______County,

Cause No. ______, Honorable ______

Petition for Review

Name:
Address:
Telephone No.:
Facsimile No.:
E-mail address:

Pro Se

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: / Name
Address
Petitioner’s trial counsel: / Name
Address
Telephone
Fax
Petitioner’s appellate counsel: / Name
Address
Telephone
Fax
Respondent: / Name
Address
Respondent’s trial counsel: / Name
Address
Telephone
Fax
Respondent’s appellate counsel: / Name
Address
Telephone
Fax
Other parties:
(if applicable) / Insert as appropriate
Counsel for other parties: / Name
Address
Telephone
Fax

TABLE OF CONTENTS

INDEX OF AUTHORITIES

STATEMENT OF THE CASE

Nature of the case:
Disposition in the trial court:
Disposition in the court of appeals:

STATEMENT OF JURISDICTION

ISSUES PRESENTED

- i -

STATEMENT OF FACTS

SUMMARY OF THE ARGUMENT

ARGUMENT AND AUTHORITIES

PRAYER FOR RELIEF

Respectfully submitted,

Name

Address

Telephone No.

Facsimile No.

E-mail address

Pro Se

CERTIFICATE OF SERVICE

In accordance with the Texas Rules of Appellate Procedure I certify that a copy of this Petition for Review was served on Respondent [Respondent’s name] through counsel of record, [counsel’s name, if applicable] by US. Mail on [date mailed].

Name

Pro Se

- 5 -

APPENDIX

TAB

1 Judgment of trial court / or order appealed from, dated ______

2 Opinion of Court of Appeals, dated ______

3 Judgment of Court of Appeals, dated ______