NOTICE OF APPEAL
In the matter of
[s-Name]
[s-Address]
RE: APPEAL FROM REFEREE'S
DECISION
[s-Number]
[t-Date]
Notice is hereby given that a
decision was reached in the above referenced matter on the above date in the
City of [s-City], State of [s-State], a copy of which is attached hereto and
sets forth the particulars in this matter.
That appellant alleges that an
error in decision has been made on the part of the referee and is appealing the
referee’s decision on the following grounds:
[insert grounds for appealing]
___________________________________ ________________________
[s-Name] [s-Date]
