Form 417a - Notice Of Appeal And Statement Of Election (Page 2 of 2) in pdf

Form 417a - Notice Of Appeal And Statement Of Election Page 2

Part 4: Optional election to have appeal heard by District Court (applicable only in

certain districts)

If a Bankruptcy Appellate Panel is available in this judicial district, the Bankruptcy Appellate Panel will

hear this appeal unless, pursuant to 28 U.S.C. § 158(c)(1), a party elects to have the appeal heard by the

United States District Court. If an appellant filing this notice wishes to have the appeal heard by the

United States District Court, check below. Do not check the box if the appellant wishes the Bankruptcy

Appellate Panel to hear the appeal.

 Appellant(s) elect to have the appeal heard by the United States District Court rather than by

the Bankruptcy Appellate Panel.

Part 5: Sign below

Date:

_____________________________________________________

____________________________

Signature of attorney for appellant(s) (or appellant(s)

if not represented by an attorney)

Name, address, and telephone number of attorney

(or appellant(s) if not represented by an attorney):

_____________________________________________________

Fee waiver notice: If appellant is a child support creditor or its representative and appellant has filed the

form specified in § 304(g) of the Bankruptcy Reform Act of 1994, no fee is required.

Official Form 417A

Notice of Appeal and Statement of Election

page 2

Form 417a - Notice Of Appeal And Statement Of Election Page 2