STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS SUPERIOR COURT NOTICE OF APPEAL Plaintiff/Petitioner Defendant/Respondent Name of Each Party and Attorney Filing Appeal Civil Action File Number Date Case First Filed in the Superior Court Party Filing Appeal Plaintiff(s) Petitioner(s) Defendant(s) Respondent(s) Other: _____________________ TRIAL COURT ACTION APPEALED IPR CON IPT CJD CDS CDM CTD CTG Preliminary Injunction Conviction Permanent Injunction Default Judgment Dismissal/Jurisdiction Dismissal Merits New Trial Motion Denied New Trial Motion Granted CJJ CDV CJU DAL PRO PTM FCJ PCR Date of Judgment or Order Appealed From Trial Court Judge Judgment/Judge Directed Verdict Judgment/Jury Alimony Probation Violation Pretrial Motion Juvenile Grant Post Conviction DPC MTR DCF DSJ ASF DRP CUS Denial Post Conviction Denial Sentence Reduction Dependency/Termination Summary Judgment Agreed Statement of Facts Original Divorce Petition Custody JUDGMENT FOR: Plaintiff(s) Defendant(s) Other BAIL/RELEASE STATUS Personal Recognizance Held Without Bail TRANSCRIPT STATUS Transcript Will Not Be Ordered Transcript Will Be Ordered Estimated Cost $___________________ SENTENCES: Confinement Special Program Fine/Restitution Surety Bond Cash Bond Suspended Probation Deferred Held In Lieu Of Bail Other Trial Court Receipt Number Appeal Filing Fee for Each Appellant or Petitioner: $150.00 Filing Fee Required: Yes No Court Reporter: ______________________________________ Rhode Island Bar Number: /s/ ________________________________________________________ Attorney for the the Plaintiff /Petitioner the Defendant/Respondent or the Plaintiff /Petitioner the Defendant/Respondent Telephone Number: Date: Superior-50 (revised March 2016) American LegalNet, Inc. www.FormsWorkFlow.com