Editable PDF:  Form 55H: Notice of Appeal

Form 55H

An Chúirt Chuarda
The Circuit Court

Notice of Appeal

Record Number: …

Circuit …                                                                    County …

In the Matter of the Assisted Decision-Making (Capacity) Act 2015, as amended

Part: …                                              Section: …

And In the Matter of

Relevant Person

Name: …                                                                Address: …

Appeal of

Appellant(s)

Name: …                                                                Address: …

And

Respondent(s) (if applicable)

Name: …                                                                Address: …

TAKE NOTICE that on

Date of Hearing: …                                         at Time: …

Court Venue: …

the Appellant will apply for orders as set out in this document, and for such further or other orders as the Court is empowered to make under said Act.

Affidavit Details:

WHICH application will be grounded upon the following affidavit(s) and the nature of the case and the reasons to be offered:

Affidavit of:                                                                            Sworn on (date)

……………………………………………………..              …………………………………

……………………………………………………..              …………………………………

Details of Order(s) requested:

………….

Signatures:

Signature of appellant(s)/Solicitor for appellant(s): …

Date: …

Solicitor Details (if applicable)

Name and Address of Solicitor: …

Email: …                                                              Phone Number: …

To:

Name and Address of Court office: …

Name and address of Notice Party(s)(if applicable): …