U.S. CODE

U.S. Code

Form 4. Affidavit Accompanying Motion for Permission to Appeal In Forma Pauperis

Apf4p1.eps Apf4p2.eps Apf4p3.eps Apf4p4.eps (As amended Apr. 24, 1998, eff. Dec. 1, 1998.) Codification Form 4 is set out in this supplement to replace an incorrect version of the form which appeared in the main edition. The form is set out as it appeared on pages 86 to 89 of House Document 105–269. Form 5 . Notice of Appeal to a Court of Appeals from a Judgment or Order of a District Court or a Bankruptcy Appellate Panel United States District Court for the XXXX District of XXXXXX 28AApF5.eps Notice of Appeal to United States Court of Appeals for the XXXXXX Circuit XXXXXXXX, the plaintiff [or defendant or other party] appeals to the United States Court of Appeals for the XXXXXX Circuit from the final judgment [or order or decree] of the district court for the district of XXXXXX [or bankruptcy appellate panel of the XXXXXX circuit], entered in this case on XXXXXX, 20XX [here describe the judgment, order, or decree] XXXXXXXXXX The parties to the judgment [or order or decree] appealed from and the names and addresses of their respective attorneys are as follows: Dated XXXXXXXXXXXX Signed XXXXXXXXXXXX Attorney for Appellant Address: XXXXXXXXXXX XXXXXXXXXXXXXX

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