YAKIMA COUNTY DISTRICT COURT _________________________________, Plaintiff vs. _________________________________, Defendant Superior Court No(s).___________________ _____________________________________ District Court No(s)____________________ _____________________________________ DOB:_____________________________ NOTICE OF APPEAL AND CERTIFICATE OF FILING STATUS 1. Appellant, , the  Plaintiff  Defendant above seeks review by the Superior Court of the Yakima County District Court decision in the above cause number entered on the date of 2. This case is: 3.  Criminal. The charge is:  Civil  Infraction Decision(s) to be reviewed:  Small Claim 4. Within 14 days of the date this Notice of Appeal is filed the appellant will file and serve on all other parties a designation of the part of the record that needs to be transmitted to Superior Court. Appellant will pay the cost of preparing the record to the Clerk of the District Court within 10 days of notification by the Clerk that the record is ready unless payment has been waived by the District Court. 5. Appellant will transcribe the electronic recording of proceedings in accordance with RALJ 6.3A and will file the transcript with the Superior Court. 6. A Defendant in a criminal case must file a statement in the Superior Court and in the District Court indicating any change in his or her address at any time during the appeal. 7. Copies of this notice will be served immediately on all other parties as required in RALJ 2.4(c). Dated: Notice of Appeal & Cert of Filing Status Page 1 of 2 7/2004 American LegalNet, Inc. www.FormsWorkflow.com Appellant’s Lawyer’s Signature Appellant’s Signature Print/Type Name & Bar Number Print/Type Appellant’s Name Address Address City State Zip City State Zip Print/Type Respondent’s Name & Counsel Address City State Zip CLERK’S CERTIFICATION OF FILING STATUS This matter is designated:  A criminal appeal for which no filing fee is required [RCW 10.10.060].  A civil, infraction, parking or contempt appeal for which a filing fee must be paid before the Notice of Appeal will be accepted for filing [RALJ 2.4(b)].  A civil, infraction or parking appeal for which an In Forma Pauperis petition has been granted and the filing fee is waived [RCW 36.18.022].  A de novo Small Claims appeal for which a filing fee must be paid before the Notice of Appeal will be accepted for filing [RALJ 1.1]. Dated: Clerk of the District Court Notice of Appeal & Cert of Filing Status Page 2 of 2 7/2004 American LegalNet, Inc. www.FormsWorkflow.com