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2. Appeal of Judgement of Magistrate
4. Case Number*
6. Plaintiff Name #1*
8. Address*
10. City*
11. State*
12. Zip Code*
16. Plaintiff Name #2
    If applicable
18. Address
20. City
21. State
22. Zip Code
26. Defendant Name #1*
28. Address*
30. City*
31. State*
32. Zip Code*
36. Defendant Name#2
    If applicable
38. Address
40. City
41. State
42. Zip Code
46. Plaintiff(s) / Defendant(s) herewith exercise his/her right to appeal the Magistrate's judgment made in this cause on this date:
47. Magistrate Judgment Date:*
    Magistrate Judgment Date:
49. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I have reviewed this document and the statements it contains are true to the best of my knowledge, information, and belief.

    1. I agree.
51. Electronic Signature*
    Signature of moving party
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit Submit and Print

* indicates a required field