IN THE COURT OF COMMON PLEAS OF WESTMORELAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW CASE NO. V. NOTICE OF APPEAL FROM AWARD OF BOARD OF ARBITRATION TO THE PROTHONOTARY: Notice is given that in this case on Please check appropriate boxes: A jury trial is demanded (If box is not checked, jury trial is waived.) I hereby certify that: The compensation of the arbitrators has been paid, OR Application has been made for permission to proceed in forma pauperis. . appeals from the award of the board of arbitrators entered __________________________________ Appellant or Attorney for Appellant PLAINTIFF'S COUNSEL Name Address DEFENDANT'S COUNSEL Name Address Phone No. ADDITIONAL DEFENDANT'S COUNSEL Name Address Phone No. ADDITIONAL COUNSEL Name Address Phone No. Prothonotary Copy Counsel Copy Phone No. Court Administrator Copy American LegalNet, Inc. www.USCourtForms.com