Free AP-102 - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT _______________________

Appellant (person bringing appeal) vs. STATE OF ALASKA DEPARTMENT OF ADMINISTRATION DIVISION OF MOTOR VEHICLES, Appellee.

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APPEAL CASE NO. NOTICE OF APPEAL (from DMV to Superior Court) [AS 28.15.166(m)]

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Notice is hereby given that appeals to the Superior Court from the decision of the Division of Motor Vehicles Hearing Officer dated _________________________, 20______. A copy of the decision is attached. STATEMENT OF POINTS The reasons for this appeal are

Date D.O.B. / A.D.L. No.

Appellant's Signature Print Name Mailing Address City State ZIP Work Phone

Home Phone I certify that on a copy of this notice and all other documents filed with it was mailed personally delivered to: __ DMV Director of Driver Licensing in Anchorage, and __ Attorney General of Alaska in Juneau By:
AP-102 (2/04) (st. 3) NOTICE OF APPEAL (from DMV to Superior Court)

App. R. 602 AS 28.15.166(m)