Form 1 "Notice of Appeal or Cross Appeal and Designation of the Record" - Arkansas

What Is Form 1?

This is a legal form that was released by the Arkansas Circuit Courts - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Arkansas Circuit Courts;
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Download a printable version of Form 1 by clicking the link below or browse more documents and templates provided by the Arkansas Circuit Courts.

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Download Form 1 "Notice of Appeal or Cross Appeal and Designation of the Record" - Arkansas

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NOTICE OF APPEAL OR CROSS APPEAL AND DESIGNATION OF THE RECORD 
Circuit Court: _________________________________ 
Circuit Court Judge: ___________________________________ 
Circuit Court Docket Number(s): ____________________________ 
Arkansas Department of Health and Human Services v. 
________________________________________________________ 
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parents
guardians
custodian 
______________________________________ [children’s initials] 
Appellant:_______________________________________________ 
COURT USE ONLY 
Appellant’s Attorney or Appellant if no Attorney 
(Name and Address)
Phone Number:                                    E­mail: 
FAX Number: 
Attorney Bar #: 
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NOTICE OF APPEAL AND DESIGNATION OF THE RECORD 
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CROSS­APPEAL AND DESIGNATION OF RECORD 
Notice is hereby given that ____________________________ as counsel for ____________________________ 
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hereby 
appeals or 
cross­appeals the order of the Circuit Court entered on ______________________(date) 
with reference to a hearing regarding: 
denial of appointed counsel 
adjudication 
disposition (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b)) 
review (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b)) 
permanency planning (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b) 
termination of parental rights 
and all adverse rulings made therein. 
DESIGNATION OF RECORD 
The  clerk  of  the  Circuit  Court  will  prepare  the  record  on  appeal,  which  shall  include,  pursuant  to  Rule  6­9,  the 
following items: 
1.  The  Circuit  Court  shall  include  all  include  all  pleadings,  motions,  reports,  exhibits,  and  orders  of  the  court 
relevant to the order from which the appeal arose as designated by the appellant: 
pleadings dated: _______________________________________________________________________ 
motions dated: _________________________________________________________________________ 
reports dated: __________________________________________________________________________ 
exhibits dated:__________________________________________________________________________ 
orders dated:___________________________________________________________________________ 
other (describe) dated:___________________________________________________________________
Rule 6­9: Form1   NOTICE OF APPEAL OR CROSS­APPEAL AND DESIGNATION OF RECORD 
Page 1 of 2 
NOTICE OF APPEAL OR CROSS APPEAL AND DESIGNATION OF THE RECORD 
Circuit Court: _________________________________ 
Circuit Court Judge: ___________________________________ 
Circuit Court Docket Number(s): ____________________________ 
Arkansas Department of Health and Human Services v. 
________________________________________________________ 
q
q
q
parents
guardians
custodian 
______________________________________ [children’s initials] 
Appellant:_______________________________________________ 
COURT USE ONLY 
Appellant’s Attorney or Appellant if no Attorney 
(Name and Address)
Phone Number:                                    E­mail: 
FAX Number: 
Attorney Bar #: 
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NOTICE OF APPEAL AND DESIGNATION OF THE RECORD 
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CROSS­APPEAL AND DESIGNATION OF RECORD 
Notice is hereby given that ____________________________ as counsel for ____________________________ 
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hereby 
appeals or 
cross­appeals the order of the Circuit Court entered on ______________________(date) 
with reference to a hearing regarding: 
denial of appointed counsel 
adjudication 
disposition (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b)) 
review (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b)) 
permanency planning (only if a final order pursuant to Ark. R. Civ. P. Rule 54(b) 
termination of parental rights 
and all adverse rulings made therein. 
DESIGNATION OF RECORD 
The  clerk  of  the  Circuit  Court  will  prepare  the  record  on  appeal,  which  shall  include,  pursuant  to  Rule  6­9,  the 
following items: 
1.  The  Circuit  Court  shall  include  all  include  all  pleadings,  motions,  reports,  exhibits,  and  orders  of  the  court 
relevant to the order from which the appeal arose as designated by the appellant: 
pleadings dated: _______________________________________________________________________ 
motions dated: _________________________________________________________________________ 
reports dated: __________________________________________________________________________ 
exhibits dated:__________________________________________________________________________ 
orders dated:___________________________________________________________________________ 
other (describe) dated:___________________________________________________________________
Rule 6­9: Form1   NOTICE OF APPEAL OR CROSS­APPEAL AND DESIGNATION OF RECORD 
Page 1 of 2 
NOTICE OF APPEAL OR CROSS APPEAL AND DESIGNATION OF THE RECORD 
2. The original transcript from the date(s)__________________________________of the proceeding resulting in 
the Circuit Court order on appeal. 
3. 
Arrangements for payment of the record have been made or 
the court has determined appellant indigent 
for payment of the record and appointment of counsel for the appeal. 
4.  The name and address of the court reporter(s) is: 
______________________________________ 
______________________________________ 
Name 
Name 
______________________________________ 
______________________________________ 
Address 
Address 
______________________________________ 
______________________________________ 
City                               State                        Zip Code 
City                               State 
Zip Code 
_____________________________________ 
______________________________________ 
Signature, attorney for appellant 
Date 
Signature of appellant 
Date 
CERTIFICATE OF SERVICE 
I  certify  that  on  ________________________  (today’s  date)  the  original  of  this NOTICE OF  APPEAL  (CROSS­ 
APPEAL) AND DESIGNATION OF RECORD was filed with the Circuit Clerk; and a true and accurate copy of this 
NOTICE OF APPEAL (CROSS­APPEAL) AND DESIGNATION OF RECORD was served on the other party(ies) 
and any court reporters listed above by any form of mail with a signed receipt to the following: 
_______________________________________ 
______________________________________ 
Name & Address 
Attorney Signature 
_______________________________________ 
Name & Address 
________________       __________________ 
Date 
Bar Number 
_______________________________________ 
Name & Address 
_______________________________________ 
OR 
Name & Address 
______________________________________ 
Appellant (if pro se litigant) Signature 
_______________________________________ 
Name & Address 
_________________ 
Date 
_______________________________________ 
Name & Address 
_______________________________________ 
Name & Address
Rule 6­9: Form1   NOTICE OF APPEAL OR CROSS­APPEAL AND DESIGNATION OF RECORD 
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