IN THE 21ST JUDICIAL CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI Judge or Division: Case Number: Plaintiff/Petitioner: Appellate Number: Filing as an Indigent Reporter’s Telephone: Sound Recording Equipment Number of Days of Trial: Date of Judgment/Sentence: Date Post Trial Motion Filed: (Attach a copy) Date Ruled Upon: Date Notice Filed: Court Reporter: vs. Defendant/Respondent: (Date File Stamp) Notice of Appeal Court of Appeals, Eastern District Supreme Court of Missouri Notice is given that _________________________________appeals from the judgment/decree entered in this action on _______________ (date). Complete if Appeal is to Supreme Court of Missouri Jurisdiction of the Supreme Court is based on the fact that this appeal involves: (Check appropriate box) The title to any state office in Missouri The validity of a treaty or statute of the United States The punishment imposed is death The construction of the revenue laws of Missouri The validity of a statute or provision of the Constitution of Missouri If the basis of jurisdiction is validity of a United States treaty or statute, the validity of a Missouri statute or Constitutional provision or construction of Missouri revenue laws, a concise explanation, together with suggestions, if desired, is required. This may be filed as part of or with this notice of appeal or, in the alternative, may be filed within ten days after the notice of appeal is filed by filing it directly with the Clerk of the Supreme Court. See Rule 81.08(b) and (c) and Rule 30.01(f) and (g). Appellant’s Attorney/Bar Number Respondent’s Attorney(s)/Bar Number(s) (If multiple, list all or attach additional sheets) Address Telephone Address Fax Telephone Appellant’s Name Respondent’s Name Address Address Telephone Fax Telephone Brief Description of Case Date of Appeal Bond Amount of Bond Signature of Attorney or Appellant CCDT229 10/07 Bond Attached Date 1 of 2 Rules 30.01, 81.08, 512.070 RSMo American LegalNet, Inc. www.FormsWorkFlow.com Notice to Appellant’s Attorney Local rules may require supplemental documents to be filed. Please refer to the applicable rule for the district in which the appeal is being filed and forward supplements as required. Directions to Clerk Serve a copy of the notice of appeal in a manner as prescribed by Rule 43.01 on the attorneys of record of all parties to the judgment other than those taking the appeal and on all other parties who do not have an attorney. (A copy of the notice of appeal is to be sent to the Attorney General when the appeal involves a felony.) Transmit a copy of the notice of appeal to the clerk of the Supreme Court/Court of Appeals. If a party does not have an attorney, mail the notice to the party at his/her last known address. Clerk shall then fill in the memorandum below. (See Rules 81.08(d) and 30.01 (h) and (i).) Forward the docket fee to the Department of Revenue as required by statute. Memorandum of the Clerk facsimile certified mail registered mail regular mail I have this day served a copy of this notice by transmission to each of the following persons at the address stated below. If served by facsimile, include the time and date of transmission and the telephone number to which the document was transmitted. ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ I have also transmitted a copy of the notice of appeal to the clerk of the Court of Appeals, Eastern District Supreme Court Docket fee in the amount of $_____________ has been received by this clerk which will be disbursed as required by statute. A copy of an order granting leave to appeal as indigent. ___________________________________________ Clerk ______________________________ Date CCDT229 10/07 By: ___________________________________________ Deputy Clerk 2 of 2 Rules 30.01, 81.08, 512.070 RSMo American LegalNet, Inc. www.FormsWorkFlow.com