IN THE COURT OF COMMON PLEAS OF NORTHAMPTON COUNTY, PENNSYLVANIA CRIMINAL

) COMMONWEALTH OF PENNSYLVANIA ) Case No. ______vs. ) ) OTN #: ______) Defendant )

NOTICE OF APPEAL Notice is hereby given that ______, Commonwealth of Pennsylvania/Defendant, above named, hereby appeals to the Supreme/Superior/Commonwealth Court of Pennsylvania from the order entered in this matter on the ______day of ______. 20____. This order has been entered in the docket as evidenced by the attached copy of the docket entry.

______[For appeals by the Commonwealth pursuant to Pa.R.A.P. 311(d)] The Attorney for the Commonwealth, by checking this paragraph, certifies that the order appealed from will terminate or substantially handicap the prosecution.

Signature ______Address ______Telephone No. ______Supreme Court No. ______Attorney for ______

ATTACHMENTS:

 Check # ______in amount of $73.50 payable to the Appellate Court  Check # ______in amount of $52.75 payable to Clerk of Judicial Records- Criminal Division  Copy of Request for Transcript  Check # ______for payment of deposit(s) on transcription costs  Proof of Service on all parties in Trial Court, Trial Judge(s), Court Reporter(s), and District Court Administrator  Above referenced docket entry

(Rev. 1/11) FILE IN DUPLICATE IN THE COURT OF COMMON PLEAS OF NORTHAMPTON COUNTY, PENNSYLVANIA CRIMINAL

) COMMONWEALTH OF PENNSYLVANIA ) Case No. ______vs. ) ) OTN #: ______) Defendant )

REQUEST FOR TRANSCRIPT [or Statement Pursuant to Pa.R.A.P. 904(c)]

A Notice of Appeal having been filed in this matter, ______the official court reporter(s) is/are hereby requested to produce, certify and file the transcript of the trial/hearing regarding ______and held on ______in conformity with Pa.R.A.P. 1922.

 There is no verbatim record of the proceedings.

 The complete transcript has been lodged of record.

 I hereby certify that the official court reporter(s) has/have informed me that the approximate length of the transcript in this case is ______pages; that the cost per page for the transcript is $______, and that the total estimated cost of this transcript will be $______.

 Attached hereto is Check # ______payable to the Court Reporter(s) for the deposit(s) required for commencement of transcription(s).

Signature ______Address ______Telephone No. ______Supreme Court No. ______Attorney for ______

(Rev. 1/11) FILE IN DUPLICATE IN THE COURT OF COMMON PLEAS OF NORTHAMPTON COUNTY, PENNSYLVANIA CRIMINAL

) COMMONWEALTH OF PENNSYLVANIA ) Case No. ______vs. ) ) OTN #: ______) Defendant )

PROOF OF SERVICE

I hereby certify that I am this day serving true and correct copies of the within Notice of Appeal, Request for Transcript, and this Proof of Service upon the persons and in the manner indicated below, which service satisfies the requirements of Pa.R.A.P. 906: (Set forth herein the manner of service and the names, addresses and telephone numbers of the persons served. See Pa.R.A.P. 906(a), which requires service on all parties in the trial court, the judge(s) of the trial court, the official court reporter(s) in the trial court and the trial court’s District Court Administrator.)

Dated: ______

Signature ______Address ______Telephone No. ______Supreme Court No. ______Attorney for ______

(Rev. 1/11) FILE IN DUPLICATE