(Revised 7/05) File Stamp Date Case Number ______ Prepared by: Filer’s name, SC# Filer’s address Filer’s phone number {Filer’s fax phone number} {Filer’s e-mail address} Attorney for Plaintiff In The District Court of ______ County, Kansas Plaintiff’s name Plaintiff vs. Defendant’s name Defendant’s address Case No. ______ Defendant Pursuant to Chapter 61 of Kansas Statutes Annotated NOTICE OF APPEAL To __________, the above-named Plaintiff (or Defendant): Take notice that ____________________, defendant (or plaintiff) does and has appealed to _______________ from the judgment (or order, ruling or decision) rendered and made in the above-entitled action on the __________ day of __________, _____, whereby it was by said court decided, ordered and adjudged that _____________. ____________________________________ Signature Dated __________ CERTIFICATE OF SERVICE I certify that I have served a copy of the above notice of appeal on ____________________, on the _____ day of ___________, _____; by depositing said notice in the United States mail, postage prepaid, in an envelope addressed to said person at the last address of such person known to me (or, by handing a copy of said notice to ____________________ at ____________________). _______________________________ Signature American LegalNet, Inc. www.USCourtForms.com