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Official Form 17 (12/04)

United States Bankruptcy Court
_______________ District Of _______________
In re _________________________, Debtor Case No. _______________________ Chapter _______________

[Caption as in Form 16A, 16B, or 16D, as appropriate]

NOTICE OF APPEAL
_____________________________________, the plaintiff [or defendant or other party] appeals under 28 U.S.C. § 158(a) or (b) from the judgment, order, or decree of the bankruptcy judge (describe) entered in this adversary proceeding [or other proceeding, describe type] on the ____________ day of , . (month) (year) The names of all parties to the judgment, order, or decree appealed from and the names, addresses, and telephone numbers of their respective attorneys are as follows:

Dated: ____________________________

Signed: ___________________________________________________ Attorney for Appellant (or Appellant, if not represented by an Attorney)

Attorney Name: ________________________________________

Address: ______________________________________________ _______________________________________________ Telephone No: _______________________________________________

If a Bankruptcy Appellate Panel Service is authorized to hear this appeal, each party has a right to have the appeal heard by the district court. The appellant may exercise this right only by filing a separate statement of election at the time of the filing of this notice of appeal. Any other party may elect, within the time provided in 28 U.S.C. § 158(c), to have the appeal heard by the district court.
If a child support creditor or its representative is the appellant, and if the child support creditor or its representative files the form specified in § 304(g) of the Bankruptcy Reform Act of 1994, no fee is required.