UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON [Caption as in Form 16A, 16B, 16C, or 16D, as appropriate] Case No. Adversary No. Debtor In re: Plaintiff v. Defendant NOTICE OF APPEAL , [plaintiff or defendant] appeals under 28 U.S.C. § 158(a) or (b) from the judgment, order, or decree of the bankruptcy judge [describe] . entered in this adversary proceeding [or other proceeding describe type] . on the day of , . [year] The names of all parties to the judgment, order, or decree appealed from and the names, addresses, and telephone numbers of their respective attorneys are as follows: Dated: Signed: Attorney for Appellant (or Appellant, if not represented by an attorney) Name: Attorney for Appellant (or Appellant, if not represented by an attorney) Address: Telephone No: If a Bankruptcy Appellate Panel Service is authorized to hear this appeal, each party has a right to have the appeal heard by the district court. The appellant may exercise this right only by filing a separate statement of election at the time of the filing of this notice of appeal. Any other party may elect, with the time provided in 28 U.S.C. § 158(c), to have the appeal heard by the district court. If a child support creditor or its representative is the appellant, and if the child support creditor or its representative files the form specified in § 340(g) of the Bankruptcy Reform Act of 1994, no fee is required. American LegalNet, Inc. www.FormsWorkFlow.com