(Appellant's Attorney's Name) Attorney for Appellant Post Office Address Phone Number IN THE DISTRICT COURT OF THE _______ JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF _______ IN THE (PUBLIC UTILITIES COMMISSION) (INDUSTRIAL COMMISSION) OF THE STATE OF IDAHO (Title of original action or proceeding together with the additional designation of parties as appellant and respondent) ) ) ) ) ) Case No. ________________ NOTICE OF APPEAL TO: THE ABOVE NAMED RESPONDENT(S), (Names), AND THE PARTY’S ATTORNEYS, (Names and Addresses), AND THE CLERK OF THE ABOVE-ENTITLED COURT (ADMINISTRATIVE AGENCY). NOTICE IS HEREBY GIVEN THAT: 1. The above named appellant(s), (Name), appeal(s) against the above-named respondent(s) to the Idaho Supreme Court from (the final judgment) (the order, describing it) _______ entered in the above-entitled action (proceeding) on the _______ day of _______ , (Honorable Judge _______ ) (Chairman _______ ) presiding. 2. That the party has a right to appeal to the Idaho Supreme Court, and the judgments or orders described in paragraph 1 above are appealable orders under and pursuant to Rule [e.g. (11(a)(2)) or (12(a))] I.A.R. 3. A preliminary statement of the issues on appeal which the appellant then intends to assert in the appeal; provided, any such list of issues on appeal shall not prevent the appellant from asserting other issues on appeal. 4. Has an order been entered sealing all or any portion of the record? If so, what portion? 5.(a) Is a reporter's transcript requested? ________________ American LegalNet, Inc. www.FormsWorkflow.com (b) The appellant requests the preparation of the following portions of the reporter's transcript: e.g. (Specific proceedings identified by date and title of hearing if less than a standard transcript is being requested) or (The reporter's standard transcript as defined in Rule 25(c), I.A.R.) or (The reporter's standard transcript as defined in Rule 25©, I.A.R. supplemented by the following:) (Voir dire examination of jury) (Closing arguments of counsel) (The following reporter's partial transcript :) (The testimony of witness "X") (Conferences on requested instructions) (Instructions verbally given by court) 6. The appellant requests the following documents to be included in the clerk's (agency's) record in addition to those automatically included under Rule 28, I.A.R. e.g. (All requested and given jury instructions) (The deposition of "X") (Plaintiff's motion for continuance of trial) 7. I certify: (a) that a copy of this notice of appeal has been served on each reporter of whom a transcript has been requested as named below at the address set out below: Name and address:______________________________________________________________ Name and address:______________________________________________________________ Name and address:______________________________________________________________ (b) (1) [ ] That the clerk of the district court or administrative agency has been paid the estimated fee for preparation of the reporter's transcript. (2) [ ] That the appellant is exempt from paying the estimated transcript fee because _______ American LegalNet, Inc. www.FormsWorkflow.com ___________________________________________________________________________ (c) (1) [ ] That the estimated fee for preparation of the clerk's or agency's record has been paid. (2) [ ] That appellant is exempt from paying the estimated fee for preparation of the record because ____________________________________________________________________ ___________________________________________________________________________. (d) (1) [ ] That the appellate filing fee has been paid. (2) [ ] That appellant is exempt from paying the appellate filing fee because ______________ ___________________________________________________________________________. (e) That service has been made upon all parties required to be served pursuant to Rule 20 (and the attorney general of Idaho pursuant to § 67-1401(1), Idaho Code). DATED THIS _______ day of _______, 20 ___. _________________________________ /s/Attorney's Signature (Name of Attorney or Firm for Appellant) Attorneys for the Appellant (When certification is made by a party instead of the party’s attorney the following affidavit must be executed pursuant to I.A.R. Rule 17(i)) State of Idaho County of ________________ ) ) ss. ) _____________________________________ , being sworn, deposes and says: That the party is the appellant in the above-entitled appeal, and that all statements in this notice of appeal are true and correct to the best of his or her knowledge and belief. _______________________________________ Signature of Appellant Subscribed and Sworn to before me this _______ day of _______, 20 __. (SEAL) ________________________________ Title American LegalNet, Inc. www.FormsWorkflow.com Residence American LegalNet, Inc. www.FormsWorkflow.com