UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF LOUISIANA
DIVISION
Civil Action No.
Plaintiff
VS.	Judge
Magistrate Judge
Defendant
NOTICE OF APPEAL

Notice is hereby given that
(Appellant's Name)
appeals to the United States Court of Appeals for the Fifth Circuit from the
(Order or Judgment)
entered in this action on	.
(Date)
Signed this	day of	, 20	.
(Attorney/Pro Se Litigant Signature)
(Printed Name)
(Street or P.O. Box)
(City)	(State)	(Zip Code)
-
(Area)	(Telephone)