Notice Of Appeal (Agency)
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Notice Of Appeal (Agency) Form. This is a Pennsylvania form and can be use in Philadelphia Local County.
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Tags: Notice Of Appeal (Agency), 10-253A, Pennsylvania Local County, Philadelphia
Attorney: _______________________________
Attorney for Appellant
ID#: ____________________________________
_____________________________
Address: ________________________________
City: _____________________ State: ________
Zip Code: _______________
Phone No.: (
) _________________
NAME (Appellant): ________________________
COURT OF COMMON PLEAS
Philadelphia County
Address: ________________________________
Term _________________________
City: _____________________ State: ________
No. ___________________________
Zip Code: _______________
Phone No.: (
) _________________
v.
_________________________________________
Agency
Notice of Appeal
Appellant (Please Print) ______________________________ hereby appeals from the adjudication
of the ____________________________________ (Agency) made on ___________________ (Date).
A Copy of Order is attached marked Exhibit “A”.
_________________________________
(Date)
___________________________________
(Signature)
PLEASE TAKE NOTICE: All parties that entered an appearance in the proceeding before
the agency may intervene as right in this appeal by filing a Praecipe to intervene within
(30) days of this notice.
10-253A
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