Attorney or Appellant, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY Attorney for Appellant UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: Debtor(s). Last four digits of Social Security Number(s): CHAPTER: CASE NUMBER: Employer’s Tax Identification No(s) [if any]: ADVERSARY NUMBER: NOTICE OF APPEAL 1. NOTICE IS HEREBY GIVEN that the (check only one box) G plaintiff G defendant or (specify name of party) G other party , appeals under 28 U.S.C. § 158(a) or (b) from the judgment, order, or decree of the bankruptcy judge (describe judgment, order, or decree) entered in this adversary proceeding or other proceeding (describe other proceeding) day of on the , (year) . 2. The names of all parties to the judgment, order, or decree appealed from and the names, addresses, telephone, and fax numbers of their respective attorneys are as follows (print or type names, addresses, telephone, and fax numbers): (Continued on next page) Revised 05/04 FORM 17 FORM 17 Notice of Appeal - Page 2 In re CHAPTER: Debtor(s). CASE NUMBER: Dated: Signature (Attorney for Appellant or Appellant if not represented by an Attorney) Attorney Name Address Telephone Number If a Bankruptcy Appellate Panel Service is authorized to hear this appeal, each party has a right to have the appeal heard by the district court. The appellant may exercise this right only by filing a separate statement of election at the time of the filing of this Notice of Appeal. Any other party may elect, within the time provided in 28 U.S.C. § 158(c), to have the appeal heard by the district court. If a child support creditor or its representative is the appellant, and if the child support creditor or its representative files the form specified in § 304(g) of the Bankruptcy Reform Act of 1994, no fee is required. Revised 05/04 FORM 17 FORM 17 Notice of Appeal - Page 3 In re CHAPTER: Debtor(s). CASE NUMBER: PROOF OF SERVICE STATE OF CALIFORNIA COUNTY OF 1. I am employed in the County of and not a party to the within action. My business address is as follows: , State of California. I am over the age of 18 2. Regular Mail Service: On , I served the documents described as: NOTICE OF APPEAL on the interested parties at their last known address in this action by placing a true and correct copy thereof in a sealed envelope with postage thereon fully prepaid in the United States Mail at , California, addressed as set forth below. G Addresses continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Dated: Typed Name Revised 05/04 Signature FORM 17