Contact information The appellant designates the following address: Documents delivered to this address will be considered received by the appellant on delivery. Further contact information is available to the respondent from the prothonotary. Signature Signed , 20 Signature of the appellant Print name: OR Signature of counsel [name] as counsel for [name] Prothonotary’s certificate I certify that this notice of appeal was filed with the court on , 20 . Prothonotary
Contact information The appellant designates the following address: Documents delivered to this address will be considered received by the appellant on delivery. Further contact information is available to the respondent from the prothonotary. Signature Signed , 20 Signature of the appellant Print name: OR Signature of counsel [name] as counsel for [name] Prothonotary’s certificate I certify that this notice of appeal was filed with the court on , 20 . Prothonotary
CIPR_Form_63_05_16_08.docx