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Rule  5531.  Description  of action. The appellant shall file together
with the record on  appeal,  in  both  criminal  and  civil  actions,  a
statement  containing  the  following information listed and numbered in
the following order:
  1. the index number of the case in the court below,
  2. the full names of the  original  parties  and  any  change  in  the
parties,
  3. the court and county in which the action was commenced,
  4.  the  date  the  action  was  commenced and the dates on which each
pleading was served,
  5. a brief description of the nature and object of the action,
  6. a statement as to whether the appeal is from a judgment or an order
or both, the dates of entry of each judgment or order appealed from, and
the name of the judge or justice who directed the entry of the  judgment
or made the order being appealed, and
  7. a statement as to the method of appeal being used:

(a) whether the appeal is on a full record, printed or reproduced, or

(b) on the original record, in which event, state whether the appendix method is being used, or leave to prosecute the appeal on the original record was granted by the court or by statute. The statement shall be prefixed to the papers constituting the record on appeal. A copy of this statement shall be filed with the clerk at the time the record on appeal is filed.