FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Attorney or Party without attorney (Name and Address)  Barstow District; 235 East Mountain View, Barstow, CA 92311  Big Bear District; 477 Summit Blvd, Big Bear Lake, CA 92315 (mailing address use Victorville District) Joshua Tree District; 6527 White Feather Road, Joshua Tree, CA 92252 Needles District; 1111 Bailey Street, Needles, CA 92363 Rancho Cucamonga District; 8303 Haven Avenue, Rancho Cucamonga, CA 91730 San Bernardino Civil District; 303 West Third St, San Bernardino, CA 92415-0210 Victorville District; 14455 Civic Drive Ste 200, Victorville, CA 92392      Appeal of (Name) Respondents CASE NUMBER NOTICE OF APPEAL (CODE ENFORCEMENT) IMPORTANT INFORMATION 1. 2. 3. 4. 5. This form must be filed with the court within 20 calendar days after the date of mailing of the final decision on the administrative review conducted by the local agency. It must be personally delivered or mailed to the court, and must be received by the court, with the required filing fee, within the 20 day period. A copy of the citation and the Administrative Ruling shall be filed with this form. There is a $25.00 fee for filing the notice of appeal. The fee must accompany this form. Make checks or money orders payable to: San Bernardino Superior Court. If your check is returned unpaid, your appeal may be void and a returned check fee will be charged. After filing this form with the court, a copy must be served by personal delivery or by first class mail on the local agency. The proof of service must be completed and returned for filing with the court at least 5 days prior to the hearing I appeal to the Superior Court, as provided by law, from the final decision of the local agency on the administrative review of my citation. __________________________________ Appellant’s name __________________________________ Citation Number __________________________________ Date ___________________________________ Appellant’s Signature 13-19890-360 New 09/2011 NOTICE OF APPEAL (Code Enforcement) American LegalNet, Inc. www.FormsWorkFlow.com FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Attorney or Party without attorney (Name and Address)  Barstow District; 235 East Mountain View, Barstow, CA 92311  Big Bear District; 477 Summit Blvd, Big Bear Lake, CA 92315 (mailing address use Victorville District)  Joshua Tree District; 6527 White Feather Road, Joshua Tree, CA 92252  Needles District; 1111 Bailey Street, Needles, CA 92363  Rancho Cucamonga District; 8303 Haven Avenue, Rancho Cucamonga, CA 91730  San Bernardino Civil District; 303 West Third St, San Bernardino, CA 92415-0210  Victorville District; 14455 Civic Drive Ste 200, Victorville, CA 92392 Appeal of (Name) Respondents CASE NUMBER PROOF OF SERVICE NOTICE OF APPEAL (CODE ENFORCEMENT) 1. At the time of service, I was at least 18 years old and not a party to this action. I served this Notice of Appeal (Code Enforcement) on the agency named below in the manner indicated below. 2. My residence or business address is as follows: 3. Manner of Service (Check and complete (a) or (b) below): (a) Personal Service. I personally delivered a true copy of the notice of appeal as follows: Name of person document left with Date of Service Time of Service Address where delivered (b) First Class Mail. I am employed in, or a resident of, the county where the notice was mailed. I deposited a true copy of the notice of appeal in the United States mail, enclosed in a sealed envelope with prepaid first class postage as follows: Date of Mailing Place of Mailing (city and State) Envelope addressed as follows: Name Address I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct ________________________________ Print Name ________________________________ Date 13-19890-360 New 09/2011 _____________________________________ Signature NOTICE OF APPEAL (Code Enforcement) American LegalNet, Inc. www.FormsWorkFlow.com