Notice Of Appeal From Administrative Agency
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Notice Of Appeal From Administrative Agency Form. This is a Indiana form and can be use in General Appellate.
Loading PDF...
Tags: Notice Of Appeal From Administrative Agency, Indiana Appellate, General
Form App. R. 9-2 Notice Of Appeal From Administrative Agency
STATE OF INDIANA
)
) SS:
)
____________________________,
Claimant(s),
vs.
____________________________,
IN THE [insert name of Administrative Agency]
CASE NO. [insert Administrative Agency number]
)
)
)
)
)
)
)
)
Respondent(s). )
NOTICE OF APPEAL FROM ADMINISTRATIVE AGENCY
[Insert designation and name of the party appealing], [by counsel or pro se - select one], pursuant
to Ind. Appellate Rule 9(I), respectfully gives notice of an appeal from the following order(s) entered by the
[insert the name of the Administrative Agency]: [list title(s) and date(s) of appealed order(s).]
This appeal is from [a final order or an interlocutory order – select one.]
This appeal will be taken to the Indiana Court of Appeals pursuant to Ind. Appellate Rule 5(C).
Pursuant to Ind. Appellate Rule 10, the [insert name of administrative agency] is requested to
assemble the Clerk’s Record, as defined in Ind. Appellate Rule 2(E).
Pursuant to Ind. Appellate Rule 11, the court reporter of the [insert name of the Administrative
Agency] is requested to transcribe, certify, and file with the [insert name of Administrative Agency] the
following hearings of record, including exhibits: [designate requested portions of the transcript]
American LegalNet, Inc.
www.USCourtForms.com
Respectfully submitted,
_______________________________________
[Insert name of Attorney or pro se party]
Address
Telephone number
CERTIFICATE OF SERVICE
The undersigned hereby certifies that a copy of the foregoing has been served upon the following by
[indicate method of service], this ____ day of __________, 20__: [insert list of parties served, see Ind.
Appellate Rule 9(A)(1)]
________________________________________
[Insert name of Attorney or pro se party]
2
American LegalNet, Inc.
www.USCourtForms.com
