Free Form 17 - Notice of Appeal - Iowa

Attorney or Appellant Name, Address , Telephone, and Fax Number

FOR COURT USE ONLY

Attorney for Appellant

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF IOWA
In re:

Debtor (s) CHAPTER ______ Debtor's Social Security No(s). CASE NUMBER ADVERSARY NUMBER Employer's Tax Identification Nos. [if any]

NOTICE OF APPEAL
1. NOTICE IS HEREBY GIVEN that the (check only one box) " plaintiff " defendant or " other party (specify name of party)____________________________, appeals under 28 U.S.C. section 158(a) or (b) from the judgment, order, or decree of the bankruptcy judge (describe judgment, order or decree) __________________________________ entered in this adversary proceeding or other proceeding (describe other proceeding) ______________________________ on the ________ day of ___________, (year) ______.

2. The names of all parties to the judgment, order, or decree appealed from and the names, addresses, telephone, and fax numbers of their respective attorneys are as follows: (Print or type names, addresses, telephone, and fax numbers)

CONTINUED ON NEXT PAGE

3/98

FORM 17

Notice of Appeal - Page Two (2)

Form 17
CHAPTER _______ Debtor. CASE NUMBER

In re

(SHORT TITLE)

Dated:

___________________________________
Signature (Attorney for Appellant or Appellant if not represented by an Attorney) (Print or type name, address, telephone and fax numbers)

If a Bankruptcy Appellate Panel Service is authorized to hear this appeal, each party has a right to have the appeal heard by the district court. The appellant may exercise this right only by filing a separate statement of election at the time of the filing of this notice of appeal. Any other party may elect, within the time provided in 28 U.S.C. section 158 (c), to have the appeal heard by the district court.

Notice of Appeal - Page Three (3)

PROOF OF SERVICE

STATE OF iOWA COUNTY OF ____________________________

1. I am employed in the County of ____________________________, State of Iowa. I am over the age of 18 and not a party to the within action. My business address is as follows:

2.

Regular Mail Service: On ________________________________, I served the documents described as: NOTICE OF APPEAL on the interested parties at their last known address in this action by placing a true and correct copy thereof in a sealed envelope with postage thereon fully prepaid in the United States Mail at _______________________, Iowa, addressed as set forth below.

q Addresses continued on attached page

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Dated:

______________________________________ Type Name

_____________________________________ Signature

3/98

FORM 17