Rule 6.751 — Form 3 July 2003 IN THE DISTRICT COURT FOR ______________________________ COUNTY IN THE INTEREST OF _______________________, CHILD(REN) Juvenile No. _______________________ NOTICE OF APPEAL (CROSS-APPEAL) (CHILD IN NEED OF ASSISTANCE AND TERMINATION CASES) TO: Clerk of the District Court for ______________________ County and (Insert names of parties) _____________________________________________________________________________________________ ____________________________________________________________________________________________ _____________________________________________________________________________________________ and Clerk of the Iowa Supreme Court NOTICE is hereby given that ____________ as counsel for ______________________________________________ hereby appeals from the (CHECK ONE) j order terminating the parent-child relationship or dismissing a petition to terminate the parent-child relationship entered pursuant to Iowa Code section 232.117 on the ______________ day of ______________________, 20 _____, j post-termination order entered pursuant to Iowa Code section 232.117 on the day of _______________________, 20 _____, j following order(s) in a child in need of assistance proceeding: _____________________________________________ entered on the _______________________________ day of _______________________, 20 _____, and all adverse rulings made herein. __________________________________________________ Signature, attorney for appellant. Name, address, telephone. __________________________________________________ Signature of appellant.* Name, address, telephone. *The signature of the appellant is required by Iowa Rule of Appellate Procedure 6.6(3). American LegalNet, Inc. www.FormsWorkflow.com 4 PROOF OF SERVICE AND CERTIFICATE OF FILING I certify that on the _______________________________ day of _______________________, 20 _____, I served this document by ( _______ personally delivering) ( _______ mailing) a copy to all other parties or attorneys whose names and addresses are shown below. I further certify that on the _________________________ day of _________________________, 20 _____, I will file this document by ( ______ personally delivering) ( ______ mailing) a copy of it to the Clerk of the District Court for ______________ County. __________________________________________________ Signature of person serving and filing notice of appeal. Name, address, telephone. Persons served: American LegalNet, Inc. www.FormsWorkflow.com