Official Form 17
United States Bankruptcy Court
_______________ District Of _______________
In re _________________________,
Case No. _______________________
[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 , .
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:
Attorney for Appellant (or Appellant, if not represented by an Attorney)
Attorney Name: ________________________________________
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.