Notice Of Intent To Appeal Family Court Final Order And Waiver Of Right To Appeal To Circuit Court {Form 1}

Form 1 NOTICE OF INTENT TO APPEAL FAMILY COURT FINAL ORDER AND WAIVER OF RIGHT TO APPEAL TO CIRCUIT COURT County Case Number STATE OF WEST VIRGINIA Family Court Judge Final Order Date In Re: Marriage/Children of: Name of Petitioner Name of Respondent Address: Address: Daytime Phone: Daytime Phone: I, ____________________________________________, hereby give notice of my intent to file an appeal from the final order of the family court directly to the Supreme Court of Appeals, and for this purpose hereby waive my right to file a petition for appeal with the circuit court. I further acknowledge that if both parties do not file a timely Notice and Waiver, any petition filed will be treated as a petition for appeal to the circuit court. _____________________________ ___________________ Signature Date 1 FCA Form 1 Confidentiality Notice: This document Dec. 2001 is not available for public inspection. <<<<<<<<<********>>>>>>>>>>>>> 2 CERTIFICATE OF SERVICE State of West Virginia County of ______________________________ I, _______________________________________, the person making this Notice and Waiver, mailed the Notice and Waiver to the following persons by first class United States Mail. Mailed to: _______________________________________________________ Address: ________________________________________________________ Date mailed: ________________________________ _____________________ Mailed to: _______________________________________________________ Address: ________________________________________________________ Date mailed: ________________________________ _____________________ ________________________________ __________________________________ _____________________ (Print your name) Signature Date 2 FCA Form 1 Confidentiality Notice: This document Dec. 2001 is not available for public inspection.