FOR COURT USE ONLY SUPERIOR COURT OF THE STATE OF CALIFORNIA MUNICIPAL COURT OF THE STATE OF CALIFORNIA JUSTICE COURT OF THE STATE OF CALIFORNIA COUNTY OF ___________________________ _____________________________________JUDICIAL DISTRICT PLANTIFF DEFENDANT COURT NUMBER NOTICE OF APPEAL NOTICE OF APPEAL of the Order, Decision or award of the Labor Commissioner in State Case Number ___________________, Dated and served upon the undersigned appellant, ______________________________________________________________________________________________________________________ on ,is given and filed pursuant to Labor Code Section 98.2. Appellant attached as Exhibit "A" a copy of the Order, Decision or Award appealed and requests that the Clerk of the Court set the cause for hearing before the above-entitled court, where it shall be heard de novo in accordance with Labor Code Section 98.2, and that the Clerk of the Court give Notice of time, date and place of the new trial to each of the following parties and the Labor Commissioner's office at the places listed below. Appellant certifies that a copy of this Notice of Appeal has been served upon the Labor Commissioner and a copy has been mailed to the Respondent, as shown below. APPELLANT (OR ATTORNEY) (NAME, ADDRESS, TELEPHONE NUMBER) OFFICE OF THE LABOR COMMISSIONER (ADDRESS AND TELEPHONE NUMBER) STATE LABOR COMMISSIONER RESPONDENT (OR ATTORNEY) (NAME, ADDRESS, TELEPHONE NUMBER) Dated Signature of Appellant State of California Department of Industrial Relations Division of Labor Standards Enforcement DLSE 537 (REV. 3/83) NOTICE OF APPEAL � English L.C. 98 85 35611 American LegalNet, Inc. www.FormsWorkFlow.com