Free Appeal to the Appellate Division - Rhode Island

State of Rhode Island and Providence Plantations Providence, SC
) ) ) ) )

Workers' Compensation Court

VS.

W.C.C. No.

CLAIM OF APPEAL TO THE APPELLATE DIVISION
And now in the above-entitled cause, within five (5) days of the date of the entry of a decree, exclusive of Saturdays, Sundays and holidays the being aggrieved by the entry of said decree on hereby files claim of appeal to the Appellate Division and hereby requests a transcript of the testimony.

Signature of attorney for the appellant
Print Attorney's Name and Registration Number

The estimated cost of the transcript of testimony in the sum of

$

has been paid.

Administrator

The reasons of appeal, together with the transcript of testimony shall be filed on or before Judge The time for filing reasons of appeal and the transcript of testimony is hereby extended to Judge The time for filing reasons of appeal and the transcript of testimony is hereby extended to Judge The time for filing reasons of appeal and the transcript of testimony is hereby extended to Judge The time for filing reasons of appeal and the transcript of testimony is hereby extended to Judge Date Date Date Date Date