Free Official Form 17 ­ USBC, EDVA - Virginia

Official Form 17

USBC, EDVA (12/03)

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA ___________________Division
In re Case No.

Debtor(s) Employer's Tax Identification (EIN) No(s). [if any]: Last four digits of Social Security No(s).: XXX-XXXXX-XX-

Chapter

NOTICE OF APPEAL
_________________________________________________________, the plaintiff [or defendant or other party] appeals under 28 U.S.C. § 158(a) or (b) from the judgment, order, or decree of the bankruptcy judge (describe) entered in this adversary proceeding [or other proceeding, describe type] on the ____________ of _______________________, ______.
(day) (month) (year)

The names of all parties to the judgment, order, or decree appealed from and the names, addresses, and telephone numbers of their respective attorneys are as follows:

Date: _____________________

Signed:________________________________________ Attorney for Appellant (or Appellant, if not represented by an Attorney) Attorney Name: Address:

Telephone No.:

If a child support creditor or its representative is the appellant, and if the child support creditor or its representative files the form specified in §304(g) of the Bankruptcy Reform Act of 1994, no fee is required.

[b17 ver. 12/03]