UNITED STATES DISTRICT COURT WESTERN DISTRICT OF LOUISIANA
CASE NO. VERSUS JUDGE MAG. JUDGE
NOTICE OF APPEAL
Notice is hereby given that (Appellant's Name) appeals to the United States Court of Appeals for the Fifth Circuit from the
(order); (judgment) entered in this action on (date) Signed this day of , 20 . .
Attorney/Pro Se Litigant (Signature)
Name (printed)
Address
Phone