UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS NOTICE OF APPEAL The following named appellant appeals to the Court from a final Board of Veterans' Appeals (BVA) decision. The Board's decision was dated . Appellant's printed name VA claims file number Appellant's telephone number Appellant's address Signature of person filing this notice Only if this Notice of Appeal is filed by a representative, check one of the following: [] [] My Notice of Appearance is attached. My representation is limited to the filing of this Notice of Appeal, and I aver to the Court, in accordance with Rule 46(b)(2), that the appellant has been advised, or alternatively will be advised, of the appellant's responsibility to abide by the Court's Rules of Practice and Procedure, including the need to timely serve and submit for filing a brief. (Complete items below). Representative's printed name Representative's phone number Representative's fax number Representative's address Representative's email address INSTRUCTIONS Send this Notice of Appeal (NOA) (original only) to: Clerk, US Court of Appeals for Veterans Claims 625 Indiana Avenue, NW, Suite 900 Washington, DC 20004-2950 The NOA will be timely if it is properly addressed to the Court and bears a legible postmark affixed by the United States Postal Service (USPS) within 120 days after the mailing date of the BVA decision that you are appealing. A postagemetered date imprint other than one affixed by USPS does not qualify. You may send this NOA by facsimile transmission to (202) 501-5848 or by means other than US mail. If you do that, or if you mail the NOA and it does not bear a legible USPS postmark, the NOA will be late if it arrives at the Court after the 120-day time limit. There is a $50 filing fee for an appeal. Send a check or money order, payable to "US Court of Appeals for Veterans Claims," with this NOA. Do not send cash. To request a waiver of the filing fee, attach a completed Form 4 (Declaration of Financial Hardship). Form 1 (Rev. 08/11) American LegalNet, Inc. www.FormsWorkFlow.com