Form Laciv 232 Notice Of Appeal - Administrative Hearing

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NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY:

STATE BAR NUMBER

Reserved for Clerk’s File Stamp

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES

COURTHOUSE ADDRESS:

CONTESTANT:

ADDRESS:

TELEPHONE NUMBER:

PROCESSING AGENCY:

ADDRESS:

TELEPHONE NUMBER:

CASE NUMBER:

NOTICE OF APPEAL - ADMINISTRATIVE HEARING

NOTICE TO CONTESTANT

The contestant is responsible for the timely filing of the Notice of Appeal. A separate Notice of Appeal - Administrative Hearing is required for each

citation. When the Court returns a copy of this notice to you with the date, place and time of the hearing filled in, you must serve a copy of this notice

upon the processing agency and file a copy of the original Proof of Service of this notice with the Court at least 10 days prior to the hearing date. The

Court may not proceed on your appeal if proof of service has not been filed.

The Contestant in the above-titled action hereby appeals to the Superior Court of California, County of Los Angeles, from

the final administrative decision on citation number: _____________________, which was issued on ______________.

(DATE)

 The hearing was

by personal conference.

by mailed declaration.

 The date of the final administrative decision was _____________________. (

)

a copy of the final decision must be attached

 The final administrative decision was

personally delivered on ______________________.