Section 3802. Filing, Service and Content of Notice of Expedited Confidential Appeal Pursuant to the Abortion Control Act, 18 Pa.C.S. § 3206

Notice of Appeal shall be filed with the Clerk of the Court of Common Pleas and immediately served on the trial judge and Court Reporter. The notice of appeal shall be in substantially the following form:

IN THE COURT OF COMMON PLEAS

OF

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COUNTY,

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DIVISION IN RE: Petition of

Trial Court
Docket No.

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(Initials of applicant)
Date Petition filed
in Trial Court

[ ] a minor
[ ] an incapacitated person

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, 19
NOTICE OF EXPEDITED CONFIDENTIAL APPEAL PURSUANT TO THE ABORTION CONTROL ACT

Notice is hereby given that

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, appellant above (initials)
designated, appeals to the Superior Court of Pennsylvania from:

[ ] The order entered in this matter on the

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day of

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, 19

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(i) which order has been entered on the docket entry, or (ii) a copy of which is attached, or

[ ] The court’s failure to grant the order requested by the petitioner within three business days from the date of the application as specified in 18 Pa.C.S. § 3206(f).

The petitioner/appellant hereby

[ ] requests

[ ] does not request that oral argument be had before the panel of judges which this appeal is assigned for decision.

The matters complained of on appeal are:

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Written notice of this appeal has been given to

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and

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(trial judge) (court reporter)

Petitioner or authorized representative.
s/

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(if signed by petitioner, initials only)
Name, address, and telephone number of person to whom confidential documents, information, and notices may be sent.

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(Name)

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(Address)

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(Telephone Number)