IN THE _______DISTRICT JUVENILE COURT OF ________ COUNTY,

STATE OF UTAH

    STATE OF UTAH 
    IN THE INTEREST OF

      )
      ) 
      )
      )
      )
___________,
Children under 18 years of age      )

  Juvenile No. __________

  NOTICE OF APPEAL [CROSS- 
  APPEAL] IN CHILD
  WELFARE  PROCEEDINGS 
   (UTAH R. APP. P. 52) 

      )  
      )
      )

(1)  Notice is hereby given that [plaintiff] [defendant] and appellant,

,

through counsel, ________________________appeals to the Utah [Supreme Court] [Court of

Appeals] the final [judgment] [order] of the Honorable Judge___________________________

entered in this matter on the ____day of ______, 200_ .  

(2a) The appeal is taken from the entire judgment.    [OR]

(2b) The appeal is taken from such part of the judgement that states that:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

__________________________
Signature of Attorney of Record 

__________________________
Signature of Appellant
__________________________
Name (Printed)
__________________________
Street Address
__________________________
City, Zip, Telephone

Revised 8/10/09

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CERTIFICATE OF SERVICE

I certify that a copy of the attached  Notice of Appeal in Child Welfare Proceedings was served
upon the party(ies) listed below by mailing it by first class mail,  personal delivery, or fax  to the
following address(es):

Name:    ______________________________

Address: ______________________________         ______ Personal Delivery

Sent Via:
______ Mail (postage prepaid)

______Fax #_______________  

   ______________________________

   ______________________________

Name:    ______________________________

Address: ______________________________         ______ Personal Delivery

Sent Via:
______ Mail (postage prepaid)

______Fax #_______________  

   ______________________________

   ______________________________

Name:    ______________________________

Address: ______________________________         ______ Personal Delivery

Sent Via:
______ Mail (postage prepaid)

______Fax #_______________  

   ______________________________

   ______________________________

By: 

______________________________

Signature

Dated: ______________________________

Revised 8/10/09

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