In the Court of Common Pleas of Lancaster County, Pa. } No. ______________, 20___ Appeal from Board of Arbitrators NOTICE OF APPEAL FROM BOARD OF ARBITRATORS TO THE PROTHONOTARY: Notice is given that_________________________________________________ ____________________________________hereby appeals to the Court of Common Pleas of Lancaster County from the award of the arbitrators entered in the above case on _________________, 20______. G A jury trial is demanded. (if box is not checked, a jury trial is waived.) I hereby certify that (check appropriate box): G The compensation of the arbitrators has been paid, or G Application has been made to proceed in forma pauperis. ______________________________ Appellant or Attorney for Appellant Arbitration fees ($ ) received on ______ day of _________________, 20____. Notices sent to__________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________ on ______________________________, 20_____. ______________________________ Deputy Prothonotary American LegalNet, Inc. www.USCourtForms.com