

Rule 100. Appendix of Forms.
| (S) |
| .................. |
| Appellant or |
| Attorney for Appellant |
| .................................. |
| Signature of Applicant |
| ........................ |
| Notary Public |
| ..................... |
| Municipal Court Judge |
| ..................... |
| Municipal Court Judge |
| [DATED AND SIGNED] |
| Name of Attorney/Party | Name of Attorney/Party |
| Address | Address |
| City, State Zip | City, State Zip |
| Telephone No. | Telephone No. |
| Attorney for Defendant | Attorney for Plaintiff |
| and Appellant | and Respondent |
| [or Defendant and Appellant, | [or Plaintiff and Respondent, |
| Pro Se] | Pro Se] |