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Fill and Sign the Ap 102 Notice of Appeal 1 12 Appeal Forms

Fill and Sign the Ap 102 Notice of Appeal 1 12 Appeal Forms

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AP-102 (1/12) (cs) App. R. 602 NOTICE OF APPEAL (from DMV to Superior Court) AS 28.15.166(m) IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT _______________________ ) ) Appellant (person bringing appeal) ) ) vs. ) ) STATE OF ALASKA ) DEPARTMENT OF ADMINISTRATION ) DIVISION OF MOTOR VEHICLES, ) APPEAL CASE NO. CI Appellee. ) ) NOTICE OF APPEAL (from DMV to Superior Court) [AS 28.15.166(m)] Notice is hereby given that appeals to the Superior Court from the decision of the Division of Motor Vehicles Hearing Officer dated _________________________, 20______. A copy of the decision is attached. STATEMENT OF POINTS The reasons for this appeal are Date Appellant’s Signature D.O.B. / A.D.L. No. Print Name Mailing Address City State ZIP Home Phone Work Phone I certify that on a copy of this notice and all other documents filed with it was mailed personally delivered to: __ DMV Director of Driver Licensing in Anchorage, and __ Attorney General of Alaska in Juneau By:

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