SUPERIOR COURT , ss Docket No. STATE OF MAINE DISTRICT COURT Location Docket No. NOTICE OF APPEAL Civil Criminal v. I, or ruling entered in this proceeding on (name of party appealing), appeal from the judgment, order (date of order appealed from). If this is a civil appeal, the Statement of the Issues (reasons for appeal) are (as follows) (attached) pursuant to M.R. App. P. 5 (b)(2)(A). This case arises from the Maine Tort Claims Act requiring the clerk to send a copy of this Notice of Appeal to the Office of the Attorney General. If this is a criminal appeal, check one of the following: The defendant is presently confined at The defendant is not in custody. The defendant’s address is CHECK APPLICABLE BOX: The Transcript Order form is attached. No transcript will be ordered. No electronic or other recording of the proceedings can be prepared for this civil case. Therefore, a statement in lieu of transcript will be prepared pursuant to M.R.App.P. 5 (d). Date: Signature of Appellant or Appellant’s Attorney Address of Appellant or Attorney: Printed name of Appellant or Appellant’s Attorney If attorney, bar number: THIS NOTICE OF APPEAL MUST BE FILED IN THE COURT THAT ISSUED THE ORDER APPEALED FROM. IT WILL NOT BE ACCEPTED OR DOCKETED UNLESS (1) IN A CIVIL CASE, IT IS ACCOMPANIED BY THE REQUIRED FILING FEE OR A MOTION TO WAIVE THE FILING FEE, AND (2) IF THE APPELLANT IS REPRESENTED, IT CONTAINS THE BAR NUMBER OF APPELLANT’S ATTORNEY. NOTICE: If this is an appeal from a civil case or a criminal case involving an adult defendant, this notice must be filed within 21 days of the entry of the judgment in the docket. If this is an appeal from a case involving the extradition of a fugitive to another state, this notice must be filed within 7 days of the entry of the judgment in the docket. Warning: Small Claims, Forcible Entry & Detainer and Juvenile matters have differing time limits for filing a Notice of Appeal. If this is an appeal from a Small Claims, Forcible Entry and Detainer or Juvenile matter, another form must be used which is available from the clerk. CV/R-162, Rev. 08/09 American LegalNet, Inc. www.FormsWorkFlow.com