IN THE SUPREME COURT OF INDIANA

NO. _________________

STATE OF INDIANA ON THE

RELATION OF JOHN J. JONES,

RELATOR,

v.

THE _____________ COURT AND THE

HONORABLE __________________, AS

JUDGE THEREOF,

RESPONDENTS.

PERMANENT WRIT OF MANDAMUS AND PROHIBITION

This original action comes before the Supreme Court on the application of Relator for a writ of mandamus and prohibition against Respondents.

After examining the application and preliminary response, hearing the oral arguments of counsel, and being advised in the premises, the court grants the application.

It is therefore ordered that Respondents, the __________ Court and the Honorable __________, as Judge thereof, [here Relator shall state the precise relief desired].

It is further ordered that the Clerk shall serve a certified copy of this permanent writ of mandamus and prohibition on Respondents, the __________ Court and the Honorable __________, as Judge thereof, . . . [here Relator shall insert the complete address of the respondent judge for mailing purposes]; . . . [here Relator shall insert the name and complete address for mailing purposes of each party opposing Relator in the respondent court]; and . . . [here Relator shall insert the name, capacity, and complete address for mailing purposes of the Attorney General, if service on the Attorney General is required by Orig. Act. R. 6(D)].

So ordered this __________ day of __________, 20___.

________________________

Chief Justice of Indiana