New Jersey Judiciary Superior Court - Appellate Division Notice of Appeal Type or clearly print all information. Attach additional sheets if necessary. Title in Full (As Captioned Below) Attorney/Law Firm/ Pro Se Litigant Name Street Address City State Zip Telephone Number Email Address: On Appeal from Trial Court Judge Trial Court or State Agency Trial Court or Agency Number Notice is hereby given that , appeals to the Appellate Division from a Judgment or Order entered on , in the (select one) Civil , Criminal , or Family Part of the Sup erior Court Tax Court or from a State Agency decision entered on . If not appealing the entire judgment, order or agency decision, specify what parts or paragraphs are being appealed. Have all issues, as to all parties in this action, before the trial court or agency been disposed of? (In consolidated actions, all issues as to all parties in all actions must have been disposed of.) Yes No If not, has the order been properly certified as final pursuant to R. 4:42 - 2? Yes No For criminal, quasi - criminal and juvenile actions only: Give a concise statement of the offense and the judgment including date entered and any sentence or disposition imposed: This appeal is from a conviction post j udgment motion post - conviction relief. If post - conviction relief, is it the 1st 2nd other specify Is defendant incarcerated? Yes No Was bail granted or the sentence or disposition stayed? Yes No If in custody, name the place of confinement: Defendant was represented below by: Public Defender self private counsel specify American LegalNet, Inc. www.FormsWorkFlow.com Notice of appeal and attached case information statement have been served where applicable on the following: Name Date of Service Trial Court Judge Trial Court Division Manager Tax Court Administrator State Agency Attorney General or Attorney for other Governmental body pursuant to R. 2:5 - 1 (a), (d) or (g) Other parties in this action: Name and Designation Attorney Name, Address and Telephone No. Date of Service Attached transcript request form has been served where applicable on the following: Date of Service Appellate Division Transcript Off i ce Clerk of the Tax Court State Agency (name) Exempt from submitting the transcript request form due to the following: No verbatim record. Transcript in possession of attorney or pro se litigant (four copie s of the transcript must be sub mitted along with an electronic copy). List the date(s) of the trial or hearing: Motion for abbreviation of transcript f i led with the court or agency below. Attach copy. Motion for transcript at public expense f i led with the court below. Attach copy. I certify that the foregoing statements are true to the best of my knowledge, information and belief. I a lso certify that, unless exempt, the filing fee required by N.J.S.A. 22A:2 - 5 and Rule 1: 43 has been paid. Date Signature of Attorney or Pro Se Litigant American LegalNet, Inc. www.FormsWorkFlow.com