Notice Of Appeal

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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________
)
)
Appellant (person bringing appeal)
)
)
vs.
)
)
)
) APPEAL CASE NO.
CI
Appellee (Name of Admin. Agency)
)
)
NOTICE OF APPEAL
(from Administrative Agency to Superior Court)
Notice is hereby given that
appeals
to the Superior Court from the decision dated
20___, of the above-named
agency. A copy of the agency’s decision is attached.
STATEMENT OF POINTS
The reasons for this appeal are
Date
Appellant's Signature
Print Name and Title (if applicable)
Mailing Address
City
State
ZIP
Home Phone
Work Phone
I certify that on
a copy of this notice and all other
documents filed with it was
mailed
personally delivered to:
__ the head of the above-named agency (list name):
__ the Attorney General of Alaska in Juneau (if agency is a state agency)
By:
AP-101 (2/04) (st.3)
NOTICE OF APPEAL (from Admin. Agency)
App. R. 602

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