500-00420 Notice of Appeal from a Decision (0/201) Page 1 of Vermont Judicial Bureau PO Box 607 White River Junction, VT 05001 www.vermontjudiciary.org JUD.VJB@vermont.gov NOTICE OF APPEAL FROM A DECISION OF THE VERMONT JUDICIAL BUREAU A decision of the hearing officer may be appealed to the Criminal Division of the Superior Court. The proceeding before the Criminal Division of the Superior Court shall be on the record, or at the option of the defendant, de novo. The def endant shall have the right to trial by jury. An appeal shall stay payment of a penalty and the imposition of points. 4 V.S.A. 247 1107(a). Case Information County : Docket (Complaint) Number: Plaintiff (State of Vermont or municipality) : Date of Decision: Party Filing the Appeal (Appellant) DEFENDANT * to choose: Appeal on the Record (meaning that neither party may present new evidence) OR De Novo Appeal (where evidence is again presented for the C ourt to consider) If de novo by judge OR by jury *See 4 V.S.A. 247 1107(a) Date: Signature: If Appellant is under the age of 18: Name of Parent or Guardian: S ignature of Parent or Guardian: This form and appropriate filing fee must be filed with the Vermont Judicial Bureau within 30 days of the issuance of the decision being appealed. American LegalNet, Inc. www.FormsWorkFlow.com