SAMPLE FORM OF NOTICE OF APPEAL (Family Court) STATE OF NEW YORK COUNTY OF FAMILY COURT In the Matter of Petitioner, -against- , Notice of Appeal Family Court Docket No. , Respondent. (Use lower Court caption) PLEASE TAKE NOTICE that the above named (Petitioner [s] or Respondent [s]) hereby appeal(s) to the Appellate Division, Third Department, from an Order entered in the office of the Family Court Clerk on _____________________, 20___ , which ______________ _____________________________________________________________________________, and from each and every part thereof. (Or describe the portion of the Order appealed if not the whole thereof.) Dated: ___________________________________ (Signature) (Print Name) (Street Address) (City, St, Zip Code) (Phone Number) TO: Family Court Clerk (Original) __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ (also send a copy to all other adverse parties and to the Law Guardian, if any) *** *** *** File with Family Court the original and two copies of the Notice of Appeal, together with one copy of a Pre-calendar statement and proof of service of these papers upon all adverse parties or their attorneys and the Law Guardian , if any. Serve one copy of the Notice of Appeal and one copy of the Pre-calendar statement upon all adverse parties or their attorneys and the Law Guardian , if any. Please note that Pre-calendar statements are not required in Family Court proceedings involving child abuse or neglect, juvenile delinquency or persons in need of supervision.