Notice of Appeal

                        NOTICE OF APPEAL
In the matter of
[name of appellant]

                      [number]     [date]

Notice is hereby given that a decision was reached in the
above referenced matter on the above date in the City of
            , State of             , a copy of which is
attached hereto and sets forth the particulars in this

That appellant alleges that an error in decision has been
made on the part of the referee and is appealing said
decision on the following grounds:  [grounds for appeal]

Date: ____________________

We are happy to provide these forms as a free service to the entire Internet community. However, please understand that these forms are general and not state specific. For a great collection of state specific forms go to