THE MUNICIPALITY OF                                                              ______________________ COUNTY                   
                                                                                                                                  
___________________________________                                
                                v.                                                                                      
___________________________________                      □ IN THE MUNICIPAL COURT OF  
                  DEFENDANT                                                                                         _____________________________, ALABAMA                          

orm MC-16 (front) Rev. 6/07      
   STATE OF ALABAMA                                                                                                                                   

                                                                                                     □ IN THE DISTRICT COURT OF 

ase Number 

  C

NOTICE OF APPEAL TO CIRCUIT COURT  
Municipal Ordinance Violation 

tate of Alabama 

Unified Judicial System 

            
DATE  OF JUDGMENT:___________________________________________________________________________ 
DATE OF DENIAL OF POST-JUDGMENT MOTION:_____________________________________________________ 
   Notice is hereby given that the above-named defendant appeals for trial de novo to the Circuit Court of  
___________________________ County, Alabama, from final judgment of conviction in this Court adjudging the 
defendant to be guilty of the offense of ______________________________________________________ 
_____________________________________________________________________________________ 
  □ TRIAL WITHOUT JURY                                                            □ DEFENDANT DEMANDS TRIAL BY JURY 
_________________   ___________                                      ________________      _________________        
 (Initials of Defendant)        (Date)                                           (Initials of Defendant)                 (Date) 
(Note: By checking either one of the boxes above, the defendant acknowledges that he or she was advised of his or her right to a jury 
trial on appeal. Also, the defendant understands that if he or she does not check the “Defendant Demands Trial By Jury” box within 
seven (7) days of filing this Notice of Appeal, he or she waives his or her right to a trial by jury in circuit court.) 

____________________________________________                                _________________________________________________________ 
Date                                                                                                     Signature of Defendant/Attorney 

___________________________________________________________________________           _____________________________________ 
Name of Attorney                                                                                                                     Attorney’s Business Telephone Number 

_________________________________________________________________________________________________________ 

Business Address of Attorney 

                 CERTIFICATION OF RECORD ON APPEAL TO CIRCUIT COURT AND COST BILL 

, the undersigned Clerk of the above court, do hereby certify that on the ____ day of ________________________________  
20____, the defendant, _____________________________________________________was convicted  in this Court of the offense  
of______________________________________________________________________ and was sentenced as follows:  
Fine: $___________;  Court Costs: $______________; Restitution: $____________ for _________________________ 
_________________________________________, such amounts being due and payable to the court, sentenced  to       
      days       months in jail,  □    other;_________________________________; and that on the _______day  of ________________            
20_____, the defendant gave Notice of Appeal to the Circuit Court of _________________________________ County.  I do  
further certify the following documents annexed hereto are all the records of the proceedings which are in my possession: 

riginal Charging Instrument: 

         □  Copy of Municipal Ordinance, if Applicable                                                □    Appeal Bond/Affidavit of Sureties (See back of form) 
         □  Non-Traffic Citation and Complaint                                                             □   Driver History Record 
         □  UTC (#_________________________)                                                     □   Case Action Summary/Record of Disposition Signed 
         □  Warrant of Arrest                                                                                               by Judge Showing Judgment and Sentence of Court 
           Other:_______________________________________________________________________________________________ 

________________________________________________                _________________________________________________ 

 Date                                                                                                                 Municipal Court Clerk              District Court Clerk  

OTE: THE ORIGINAL AND COPIES OF THIS NOTICE OF APPEAL MUST BE STAMPED IMMEDIATELY UPON RECEIPT. 

Filed in this office on this ___________  day of ____________________, 20_________ 

RIGINAL: Circuit Court                                                           COPY: Lower Court                                                                    COPY: Defendant 

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MC-16(back) Rev. 6/07

NOTICE OF APPEAL TO CIRCUIT COURT
Municipal Ordinance Violation 
 

Case Number

 

 

APPEAL BOND

 

I, 

(Defendant), as principal, and

I (we) (please print) ________________________________________________________________ 

, as surety(ies), agree to

pay the Municipality of ___________________________________________ , Alabama, the sum of $_______________ 
(not to exceed $1,000 or twice the amount of fine and costs) and all costs incurred in this Court and on appeal in this
Court unless the above-named Defendant appears before the circuit court on the scheduled date and from time to
time thereafter until discharged by law to answer this charge of _________________________________________   
                                                                                                                                             , or any other charge as authorized by law.
  We hereby severally certify that we have property valued over and above all debts and liabilities that have a fair
market value equal to or greater than the amount of the above bond and we, and each of us, waive the benefits of
all laws exempting property from levy and sale under execution or other process for the collection of debt by the
Constitution and laws of the State of Alabama, and we especially waive our rights to claim exempt our wages or
salary, that we have under the laws of Alabama and our rights to homestead exemptions that we have under the
Constitution of Alabama and the laws of the State of Alabama, as set out in a separate writing. 

It is further agreed and understood that this is a continuing bond which shall remain in full force and effect until

such time as the undersigned are duly exonerated.

Signed and sealed this date with notice that false statements are punishable as perjury. 

 
Date 
 
Home or Business Address 

 
Signature of Defendant 

 
Cl ty 

 
State
AFFIDAVIT OF SURETY(IES)

 
Zip Code

(L.S.)

 

Home or Business Telephone Number 

In addition to the statements made above, _____________________________________________________,

 
the undersigned Surety(ies), hereby certify [that I (we) am/are not [an] attorney(s), [a] judicial official(s),  
or [a] person(s) authorized to take bail and]* that I(we) own property in this state that has a fair market value equal
to or greater than the amount of the appeal bond in this cause, exclusive of property exempt from execution
and above and over all liabilities, including the amount of all other outstanding appeal bonds entered into 
by me (us). [If the surety's(ies') property is valued at less than the amount of the bond and  is to be aggregated with
the property of other sureties, state the value of the surety's(ies') property exclusive of liabilities and exemptions].                                                                                                          
 
SURETY NUMBER 1 – Property** _______________________________________________________________________________________ 
Exemptions and Liabilities**  ______________________________________________________________________________________________________________
Other Outstanding Surety Bonds: Number __________________________________Aggregate Amount: $ ______________________________  
 
Surety's Name (Print) 
 
Surety's Business Address 

 
Business Telephone Number 

 
Social Security Number 

 
Signature of Surety 

 
Zip Code

 
State

 
City 

(L.S.)

  * Does not apply: Immediate Family Member. Specify Relationship 
* *Attach a separate sheet if necessary 

 

SURETY NUMBER 2. - Property** 
Exemptions and Liabilities**  
Other Outstanding Surety Bonds: Number 
 
Surety's Name (Print) 
 
Surety's Business Address 

 

 
City 

  * Does not apply: Immediate Family Member. Specify Relationship 
**Attach a separate sheet if necessary 

Bond 

□    APPROVED

□   WAIVED

this the  
 

day of 
 

,20 

 

 

 
Signature

Title   

Aggregate Amount: $  

 
Social Security Number 

 
Signature of Surety 

(L.S.)

 
State

 
Zip Code

 

Business Telephone Number