Form 1-4/18 - Notice Of Appeal - United States Court Of Appeals For Veterans Claims
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5UNITED STATES COURT OF APPEALS
FOR VETERANS CLAIMS
N
A
OTICE OF
PPEAL
The following named appellant appeals to the Court from a final Board of Veterans' Appeals
(BVA) decision. The Board's decision was dated
.
________________________________
_____________________________
Appellant's printed name
VA claims file number
________________________________
_____________________________
Appellant's telephone number
_______________________________
_______________________________
_____________________________
Appellant's address
Signature of person filing this notice
Only if this Notice of Appeal is filed by a representative, check one of the following:
[ ]
My Notice of Appearance is attached.
[ ]
My representation is limited to the filing of this Notice of Appeal, and I aver to the
Court, in accordance with Rule 46(b)(2), that the appellant has been advised, or
alternatively will be advised, of the appellant's responsibility to abide by the Court’s
Rules of Practice and Procedure, including the need to timely serve and submit for
filing a brief. (Complete items below).
_________________________
_____________________
Representative's printed name
Representative's phone number
____________________________
_______________________
____________________________
Representative's fax number
___________________________________
_____________________________
Representative's address
Representative's email address
INSTRUCTIONS
You may send this NOA by facsimile
Send this Notice of Appeal (NOA)
transmission to (202) 501-5848 or by
(original only) to:
means other than US mail. If you do
that, or if you mail the NOA and it does
Clerk,
not bear a legible USPS postmark, the
US Court of Appeals for Veterans
NOA will be late if it arrives at the Court
Claims
after the 120-day time limit.
625 Indiana Avenue, NW, Suite 900
Washington, DC 20004-2950
There is a $50 filing fee for an appeal.
Send a check or money order, payable to
The NOA will be timely if it is properly
"US Court of Appeals for Veterans
addressed to the Court and bears a
Claims," with this NOA. Do not send
legible postmark affixed by the United
cash. To request a waiver of the filing
States Postal Service (USPS) within 120
fee,
attach
a
completed
Form
4
days after the mailing date of the BVA
(Declaration of Financial Hardship).
decision that you are appealing.
A
postage-metered date imprint other than
one affixed by USPS does not qualify.
Form 1 (Rev. 08/11)
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