Form 61A

Courts of Justice Act

notice of appeal to an appellate court

(General heading in accordance with Form 61B)

notice of appeal

THE (identify party) APPEALS to the Court of Appeal (or Divisional Court) from the judgment (or order) of (name of judge, officer or tribunal) dated (date) made at (place).

THE APPELLANT ASKS that the judgment be set aside and a judgment be granted as follows (or that the judgment be varied as follows, or as may be):  (Set out briefly the relief sought.)

THE GROUNDS OF APPEAL are as follows:  (Set out briefly the grounds of appeal.)

THE BASIS OF THE APPELLATE COURT’S JURISDICTION IS:  (State the basis for the appellate court’s jurisdiction, including (i) any provision of a statute or regulation establishing jurisdiction, (ii) whether the order appealed from is final or interlocutory, (iii) whether leave to appeal is required an if so whether it has been granted, and (iv) any other facts relevant to establishing jurisdiction.)

(Divisional Court appeals)  The appellant requests that this appeal be heard at (place).

(Date)

(Name, address and telephone and fax numbers of appellant’s lawyer or of appellant)

TO       (Name and address of respondent’s lawyer or of respondent)

RCP-E 61A (November 1, 2005)