National Transportation Safety Board Notice Of Appeal
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1NATIONAL TRANSPORTATION SAFETY BOARD
Office of Administrative Law Judges
490 L’Enfant Plaza East, SW
Washington, DC 20594
Telephone: 202-314-6150; Toll Free: 1-800-854-8758; Facsimile: 202-314-6158
ADMINISTRATOR,
Federal Aviation Administration
Complainant,
FAA Case Number _________________________
v.
_________________________________________,
Respondent.
NOTICE OF APPEAL
Respondent, pursuant to the Board’s Rules of Practice (49 C.F.R. Part 821), hereby
appeals the Administrator’s Order dated ___________________________, a copy of which is
enclosed.
Respectfully submitted,
Signature:
______________________________________
Typed or Printed Name:
______________________________________
Address:
______________________________________
Address:
______________________________________
Telephone:
______________________________________
Facsimile:
______________________________________
CERTIFICATE OF SERVICE
xx I hereby certify that I mailed a copy of the foregoing Appeal to FAA Attorney: ___________________________________
address: _____________________________________________________________________________________________
on the __________ day of ________________, 20____.
Check all that apply:
certified mail
fax
overnight mail
I hereby certify that I mailed the Original and three (3) copies of the foregoing Notice of Appeal to the National
Transportation Safety Board, Office of Administrative Law Judges, 490 L’Enfant Plaza East, SW, Washington, DC 20594.
Check all that apply:
certified mail
fax
overnight mail
_______________________________________________
_______________________________________________
Typed or Printed Name
Signature
ORIGINAL & THREE (3) COPIES – NTSB JUDGES OFFICE
COPY – FAA ATTORNEY
COPY – YOUR RECORDS
NTSB FORM 2005.2 (Rev. 2/2012)
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