800-00005 -Notice of Appeal (05/2017) Page 1 of 1

Vermont Supreme Court 109 State Street Montpelier, VT 05609-0801

802-828-4774 www.vermontjudiciary.org

NOTICE OF APPEAL Vermont Rules of Appellate Procedure (V.R.A.P.) 3 and 4

IN THE SUPREME COURT OF THE STATE OF VERMONT

For Superior Court Appeals: UNIT:

DIVISION:

For Board or Agency Appeals: BOARD OR AGENCY NAME:

For All Appeals: CASE NAME:

DOCKET NUMBER:

Notice is given that _________________________________________, ______________________, appeals to (name of party appealing) (Plaintiff/Defendant)

the Supreme Court from ____________________________________________________________________ (describe order being appealed)

entered on the _______ day of _______________________________, 20_____.

Signature: _______________________________________________ Date: _______________________

Name:

Mailing address:

Phone:

Email address:

Attorney for:

NOTE: This form must be filed with the superior court clerk or administrative agency and a copy sent to the Supreme Court docket clerk, counsel of record for each represented party, and any self-represented party. V.R.A.P. 3(b). The form may be used for any appeal to the Supreme Court, whether from the superior court or an administrative agency.

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