IN THE CIRCUIT COURT OF THE FOURTEENTH JUDICIAL CIRCUIT ROCK ISLAND COUNTY, ILLINOIS People of the State of Illinois VS. CASE # NOTICE OF APPEAL An appeal is taken from the Order or Judgment described below. 1. Court to which appeal is taken: Third Judicial District, 1004 Columbus Street, Ottawa, Il 61350 2. Name of appellant and address to which notice shall be sent. NAME ADDRESS: 3. Name and address of Appellants Attorney on appeal. NAME: ADDRESS: TELEPHONE: If appellant is indigent and has no Attorney, does he want one appointe d? 4. Date of order or judgment: 5. Offense of which convicted: 6. Sentence: 7. If appeal is not from a conviction, nature of order appealed from: SIGNED: American LegalNet, Inc. www.USCourtForms.com