New Mexico > Appellate Courts > Court Of Appeals
Notice Of Appeal (Workers Compensation Appeal) - New Mexico
| Notice Of Appeal (Workers Compensation Appeal) Form. This is a New Mexico form and can be used in Court Of Appeals Appellate Courts . |
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This is a Notice of Appeal for a WORKERS COMPENSATION APPEAL to the New Mexico Court of Appeals. You must type or word process all of the information required on this form. File a CaseInformation Sheet with this Notice of Appeal. File the original of this Notice of Appeal with theCourt of Appeals. IN THE COURT OF APPEALS OF THE STATE OF NEW MEXICO , (full name of the worker) Worker-Appell , vs. Court of Appeals Number: (LEAVE BLANK) WCA Number: (complete WCA Number) WCA Judge: (Name of Judge) , (full name(s) of the Employer/Insurance Company) Employer-Appell , Insurer-Appell , NOTICE OF APPEAL 1. The party appealing is: . (Your full name) 2. I am appealing against . (Enter the name(s) of the party (or parties) you are appealing against.) 3. I am appealing the orders or judgments listed below: (Attach copies of these orders/judgments to this Notice.) (1) Date of Order/Judgment (2) Date of Order/Judgment (3) Date of Order/Judgment <<<<<<<<<********>>>>>>>>>>>>> 24. I am appealing to the New Mexico Court of Appeals. 5. If you will have counsel on appeal, enter your attorneys full name and address here: Name: Address: City, State, Zip: Telephone: Sign this form below. Be sure you attach an affidavit of service. Respectfully submitted: Sign your name: Print or type your name: Your address: City, State, Zip Code: Telephone Number: <<<<<<<<<********>>>>>>>>>>>>> 3You must type or word process all of the information required on this for m. AFFIDAVIT OF SERVICE FOR NOTICE OF APPEAL IN A WORKERS COMPENSATION APPEAL (your full name), being duly sworn upon his or her oath or affirmation,hereby declares under penalty of perjury that he or she [mailed] [personally delivered](circle or underline one of the foregoing - the one that you did) the foregoing notice of appeal to the following people or entities at the addresses indicated on this day of , .(put the date you mailed or delivered the notice of appeal) The following spaces are for the names and addresses of the people you are required to mail or deliver the notice of appeal to. You must fill them all in. The WCA clerk or the judges secretary may be able to help you with these names and addresses. CLERK OF COURT WORKERS COMPENSATION ADMINISTRATION P.O. BOX 27198 ALBUQUERQUE, NM 87106 (name of the WCA judge) (street or P.O. address of the W CA judge) (city, state and zip code of WCA judge) (name of opposing counsel) (street or P.O. address of opposing counsel) (city, state and zip code of opposing counsel) <<<<<<<<<********>>>>>>>>>>>>> 4 (name of the court reporter or monitor) (street or P.O. address of court reporter or monitor) (city, state and zip code of court reporter or monitor) (Sign your name in front of Notary Public)Subscribed and sworn to before me this day of , . Notary PublicMy Commission Expires:
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