500-00420 – Notice of Appeal from a Decision (03/2019) Page 1 of 1
Vermont Judicial Bureau
PO Box 607
White River Junction, VT 05001
Phone: 802-295-8869
www.vermontjudiciary.org
JUD.VJB@vermont.gov
NOTICE OF APPEAL FROM A DECISION OF THE VERMONT JUDICIAL BUREAU
A decision of the hearing officer may be appealed to the Criminal Division of the Superior Court. The
proceeding before the Criminal Division of the Superior Court shall be on the record, or at the option of the
defendant, de novo. The defendant shall have the right to trial by jury. An appeal shall stay payment of a
penalty and the imposition of points. – 4 V.S.A. § 1107(a).
Case Information
County: ______________________________________
Docket (Complaint) Number: ______________________________________
Plaintiff (State of Vermont or municipality): ______________________________________
Defendant’s Name: ______________________________________
Date of Decision: ______________________________________
Party Filing the Appeal (Appellant)
Appellant’s Name: ______________________________________
Appellant’s Address: ______________________________________
______________________________________
______________________________________
Appellant’s Phone Number: ______________________________________
DEFENDANT* to choose:
☐ Appeal on the Record (meaning that neither party may present new evidence)
OR
☐ De Novo Appeal (where evidence is again presented for the Court to consider)
If de novo
☐ by judge
OR
☐ by jury
* See 4 V.S.A. § 1107(a)
Date: ________________ Signature: _______________________________
If Appellant is under the age of 18:
Name of Parent or Guardian: ______________________________________
Signature of Parent or Guardian: ______________________________________
This form and appropriate filing fee must be filed with the Vermont Judicial Bureau within 30 days of the
issuance of the decision being appealed.
