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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.

NOTICE OF APPEAL - Judiciary of Vermont800-00005 -Notice of Appeal (05/2017) Page 1 of 1 Vermont Supreme Court 109 State Street Montpelier, VT 05609-0801 802-828-4774

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  • 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.

    2: [ ]3: [ ]4: 5: 6: a: b: [ ]c: d: e: f: 13: 14: 15: 16: 17: 12: g: