1 2 3 4 5 6 7 8 vs. 9 10 11 12 13 14 15 Submitted by: 16 17 18 19 20 21 22 23 24 25 26 27 28 NOTICE OF APPEAL AND REQUEST FOR TRIAL DE NOVO - Page 1 of 1 FC (6/12/03) Certificate of Document Preparation You are required to truthfully complete this certificate regarding the document(s) you are filing with the court. Check or complete all blanks that apply. I certify that: ______________________________________ Plaintiff/Defendant, Pro Se (print name) ______________________________________ Address ______________________________________ City, State, Zip Code ______________________________________ Telephone _____________________________________ Signature of Plaintiff/Defendant ________________________________, Defendant/Respondent. ________________________________, Plaintiff/Petitioner, ) ) ) ) ) ) ) ) NOTICE OF APPEAL FROM ARBITRATION AWARD AND REQUEST FOR TRIAL DE NOVO Case No. _____________________ IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT
9 Plaintiff 9 Defendant hereby gives notice of appeal from the arbitration award filed in this
case on ___________________________ and requests a trial de novo on all issues of law and fact.
9 9 9 9
I selected the document(s) for myself. I was provided the document(s) by an attorney. I completed the documents without paid assistance. I paid or will pay money to ____________________________ for assistance in preparing the document(s)/form(s). ________________ Dated __________________________________ Signature