Notice: Notice is hereby given that
(List Name(s) of all appealing party(ies) *Use
Additional sheet if necessary*
appeals as follows:
Appeal to: Supreme Court Post-Conviction Parental Termination
Worker’s Comp Case Capital Case
Court of Appeals Court of Criminal Appeals
Appealed from: Circuit Chancery Criminal ( Misdemeanor Felony)
Juvenile Probate General Sessions Claims Commission
County:___________________________________ Trial Court No.: ________________________
Trial Judge:_______________________________File Date of Judgment Appealed:___________
Bond on appeal is: Filed (Copy Attached) Indigent Not required Cash bond
If not required, state reason: ___________________________________________________
(**Copy of Affidavit/Order of Indigency must be attached**)
[Party(ies) initiating the appeal]
Appellant: At trial: Plaintiff Defendant
Party’s Address:____________________________________________________________
Party’s Telephone:
* Attach an additional sheet for each additional Appellant *
Appellee: At trial: Plaintiff Defendant
Appellee’s Address:
Attorney’sName: _______________________________ BPR#:
Attorney’s Address: Phone:
* Attach an additional sheet for each additional Appellee *
Attorney or Pro Se Party(ies):
Name (please print) Signature BPR Number
Address of Attorney or Pro Se Party:
Attach Certificate of Service - Tenn. R. App. P. 20