______ Attorney at Law
IN THE WORKERS' COMPENSATION COURT OF THE STATE OF MONTANA WCC No.
Petitioner vs.
Respondent/Insurer. _____________________________________________________________________ NOTICE OF APPEAL ¶1 NOTICE IS HEREBY GIVEN that the Petitioner __________ appeals to the Supreme Court of the State of Montana from the FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER, entered into this action on _________________, 200__. ¶2 This matter is subject to mediation under Rule 54, Mont. R. App. P. DATED this _____ day of ______________, 200__. By:__________________________________ Attorneys for ______________________