Free AP-101 - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________ ) ) ) ) ) ) ) ) APPEAL CASE NO. CI ) ) NOTICE OF APPEAL (from Administrative Agency to Superior Court) appeals 20___, of the above-named

Appellant (person bringing appeal) vs.

Appellee (Name of Admin. Agency)

Notice is hereby given that to the Superior Court from the decision dated 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 Work Phone

Home 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