IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT _____________________ ) ) ) ) ) ) ) ) ) ) ) Appellant (person bringing appeal) vs. Appellee APPEAL CASE NO. CASH DEPOSIT ON APPEAL CI I am depositing cash in lieu of a bond as described below. I understand that if the appeal is dismissed or if the judgment/decision is affirmed or modified, the court may order that part or all of this cash deposit be paid to the appellee to cover appeal costs, and if the cash deposit is in lieu of a supersedeas bond the court may also order that it be paid to the appellee to pay the judgment, post-judgment costs and interest. If the court reverses the judgment/decision, the money I am depositing will be returned to me without interest. Cash deposit in the amount of $_________ in lieu of a Cost Bond. I understand that this deposit will not result in a stay of execution of the judgment. Cash deposit in the amount of $_________ in lieu of a Supersedeas Bond. I understand that this deposit will stay execution of the judgment. I am the owner of the cash deposited. I submit myself to the jurisdiction of the court and irrevocably appoint the clerk of court as my agent upon whom any papers affecting this deposit may be served. I agree that it is not necessary for an independent action to be filed in order for this deposit to be used as described above. Date Type or Print Name Telephone No. Signature of Owner of Cash Mailing Address City State Zip ACKNOWLEDGMENT The foregoing instrument was acknowledged before me this date, __________________, 20___, by ___________________________, who personally appeared before me and acknowledged that he/she executed the instrument for the purposes stated in it. (SEAL) I certify that on a copy of this form was mailed personally delivered to (list names): Clerk of Court/Notary Public My commission expires: Amt. Deposited $________ Receipt No. ____________ Date ___________ Clerk ___________ By: AP-110 (1/05)(cs) CASH DEPOSIT ON APPEAL App. R. 204(c), 602(g) Civil Rule 80(f) & (g) American LegalNet, Inc. www.USCourtForms.com