(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 vs. Defendant's name Defendant's address Defendant Plaintiff Case No. ______ Pursuant to Chapter 61 of Kansas Statutes Annotated NOTICE OF APPEAL To ______________, the above-named plaintiff: Take notice that the above-named defendant does and has appealed to ______________ from the judgment entered and made in the above-entitled action on the ____ day of _________, ____, whereby the court rendered judgment against the defendant and in favor of the plaintiff for restitution of the premises described in the plaintiff' petition herein and for costs and rent. s ___________________________________ 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.FormsWorkFlow.com