(Rev. 12/6/12) UNITED STATES DISTRICT COURT WESTERN DISTRICT OF LOUISIANA DIVISION Civil Action No. Plaintiff VS. Judge Magistrate Judge Defendant NOTICE OF APPEAL Notice is hereby given that (Appellant's Name) appeals to the United States Court of Appeals for the Fifth Circuit from the (Order or Judgment) entered in this action on (Date) Signed this day of , 20 . . (Attorney/Pro Se Litigant Signature) (Printed Name) (Street or P.O. Box) (City) (Area) (Telephone) (State) (Zip Code) American LegalNet, Inc. www.FormsWorkFlow.com