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These rules shall be known as the Uniform Municipal Court Rules of Appeal to District Court and may be cited as U.M.C.R.App. 14 APPENDIX OF FORMS FORM 1. NOTICE OF APPEAL TO A DISTRICT COURT FROM A JUDGMENT OR ORDER OF A MUNICIPAL COURT. IN THE MUNICIPAL COURT OF THE CITY OF COUNTY OF ,STATE OF MONTANA , IN THE A.B., Plaintiff, vs. C.D., Defendant. Notice of Appeal Notice is hereby given that C.D., defendant/plaintiff above-named, hereby appeals to , state of Montana the (from the final judgment) (from the order) (describing it) entered in this action on the __ day of district court in the county of ,19 __ . Dated: , 19_ . (S) Appellant or Attorney for Appellant 15 FORM 2. AFFIDAVIT TO ACCOMPANY MOTION FOR LEA VE TO APPEAL IN FORMA PAUPERIS. IN THE MUNICIPAL COURT OF THE CITY OF _______ , IN THE COUNTY OF ,STATE OF MONTANA A.B., Plaintiff, vs. C.D., Defendant. AFFIDAVIT IN SUPPORT OF APPLICATION TO PROCEED ON APPEAL WITHOUT PREPAYMENT OF COSTS I, , being first duly sworn, depose and say that I am the ____ __ in the above-entitled case; that in support of my application to proceed on appeal without being required to prepay fees, costs or give security therefor, I state that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am entitled to redress; and that the issues which I desire to present on appeal are the following: I further swear that the responses which I have made to the questions and instructions below relating to my ability to pay the cost of prosecuting the appeal are true. 1. Are you presently employed? a. If the answer is yes, state the amount of your salary or wages per month and give the name and address of your employer. b. If the answer is no, state the date of your last employment and the amount of the salary and wages per month which you received. 2. Have you received within the past 12 months any income from a business, profession or other form of self-employment, or in the form of rent payments, interest, dividends, or other source? a. If the answer is yes, describe each source of income, and state the amount received from each during the past 12 months. 3. Do you own any cash or checking or savings account? a. If the answer is yes, state the total value of the items owned. 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary household furnishings and clothing)? a. If the answer is yes, describe the property and state its approximate value. 5. List the persons who are dependent upon you for support and state your relationship to those persons. 6. List all your debts and moneys owed. 16 I understand that a false statement or answer to any question in this affidavit will subject me to penalties for perjury. Signature of Applicant Subscribed and sworn to before me this_ day of ____ , 19_. Notary Public ORDER Let the applicant proceed without prepayment of costs. DATED: ___ _ Municipal Court Judge OR The applicant's application to proceed without prepayment of costs is denied for the reason [state reason for denial] DATED: ___ _ Municipal Court Judge 17 FORM 3. DISPOSITION OF APPEAL BY ORDER. MONTANA. __ __ _ JUDICIAL DISTRICT COURT, __ ____ COUNTY. A.B., Plaintiff and Respondent, vs. C.D., Defendant and Appellant. ORDER The court having considered the appeal in this case, the (final judgment) ( order) day of __ _ (describing it) entered by the municipal court in this action on the 19 __ is [affirmed.] [the appeal is dismissed for (describe the reason)] [reversed and remanded to the municipal court for (describe action to be taken) ] [amended as follows (describe amendment) ]. [DATED AND SIGNED] 18 FORM 4. PAGE ONE OF BRIEF. MONTANA _____ ,JUDICIAL DISTRICT COURT, _ __ _ _ COUNTY A.B., Plaintiff and Respondent, vs. C.D., Defendant and Appellant Cause No. - - - - - District Judge: __ _ BRIEF OF APPELLANT ON APPEAL FROM THE MUNICIPAL COURT OF THE CITY OF THE COUNTY OF ____ __ Presiding, Cause No. __ _ , IN , STATE OF MONTANA, Municipal Judge Name of Attorney/Party Address City, State Zip Telephone No. Attorney for Defendant and Appellant [ or Defendant and Appellant, Pro Se] Name of Attorney/Party Address City, State Zip Telephone No. Attorney for Plaintiff and Respondent [ or Plaintiff and Respondent, Pro Se] 19