Clerks Date Stamp: DISTRICT COURT OF WASHINGTON COUNTY OF JEFFERSON State of Washington ( ) City of Port Townsend, ( ) check one Plaintiff No. NOTICE OF APPEAL TO SUPERIOR COURT ___________________________________, Defendant ____________________________________ 1. CASE TYPE: _____CRIMINAL DATE OF VIOLATION__________________ _____CIVIL _____SMALL CLAIMS _____TRAFFIC INFRACTION Note: If criminal or traffic infraction, state specific charge/infraction & RCW _____________________________________________________________________________________________ _____________________________________________________________________________ 2. The appellant, ___________________________, seeks review by the Superior court of the District Court decision in cause number_____________entered on the____day of__________. 20__. 3. Errors claimed are:___________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________. 4. Location of claimed errors in the record is: (CD# and CD location)__________________________ _____________________________________________________________________________________________ _____________________________________________________________________________ 5. Trial Court Judge (who presided over the trial) ____________________________________________ DATED: __/__/__ __________________________________________ APPELLANT’S SIGNATURE __________________________________________ Appellant’s Name (print or type) __________________________________________ Address __________________________________________ Telephone OPPOSING PARTY AND COUNSEL Name_________________________________ Name_______________________________________ Address_______________________________ Address_____________________________________ _______________________zip____________ _______________________________zip___________ Telephone_____________________________ Telephone____________________________________ American LegalNet, Inc. www.FormsWorkflow.com