Designation Of Record For Appeal From District Court Page 3
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3in the sum of $_________.
E. DATE, SIGNATURE, AND SERVICE BY COUNSEL OR PARTY
DATE: _______________, 20_____.
Verified by (Signature of Attorney or Pro Se Party)
Attorney for (Appellee or Appellant)
OBA No.
Firm
Address
Telephone
CERTIFICATE OF SERVICE
I, _________________________, hereby certify that in addition to filing the original
Designation of Record in the district court, a copy of the foregoing Designation of Record was
mailed by first class mail, postage prepaid, this _____ day of _________ 20_____, to the
following:
[Names and Addresses of all parties or their counsel of record]
_______________________________________
_______________________________________
_______________________________________
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