Free Form 3 - Hawaii

IN THE CIRCUIT COURT OF THE FIRST CIRCUIT STATE OF HAWAI#I

) ) Plaintiff, ) ) v. ) ) ) Defendant. ) ________________________ )

DOCKET NO. NOTICE OF APPEAL

NOTICE OF APPEAL Notice is hereby given that by and through his/her attorney, ,

, pursuant to , Hawai#i Revised Statutes, and Rule 72 of the Hawai#i Rules of Civil Procedure (and) , appeals to the Circuit Court of the First Circuit from the decision and order of the
Other (name agency/commission/board)

,

filed herein on

, and (attached hereto Exhibit "A"). .

DATED: Honolulu, Hawai#i,

___________________________________ Attorney for Petitioner

IA-P-003 (12-05)

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