United States District Court for the ________

District of ____________

Notice of Appeal to United States Court of Appeals for the ____________ Circuit

________________, the plaintiff [or defendant or other party] appeals to the United States Court of Appeals for the ____________ Circuit from the final judgment [or order or decree] of the district court for the district of ____________ [or bankruptcy appellate panel of the ____________ circuit], entered in this case on ____________, 20____ [here describe the judgment, order, or decree] ____________________

The parties to the judgment [or order or decree] appealed from and the names and addresses of their respective attorneys are as follows:

Dated ________________________      

Signed ________________________      

Attorney for Appellant      

Address: ______________________      

____________________________      

[Note to inmate filers: If you are an inmate confined in an institution and you seek the timing benefit of Fed. R. App. P. 4(c)(1), complete Form 7 (Declaration of Inmate Filing) and file that declaration along with this Notice of Appeal.]