MUNICIPAL COURT FOR THE CITY OF ___________________, TENNESSEE

CITY OF ____________________                                CASE # ________________

            VS.

_____________________________

APPEAL BOND

The undersigned Defendant (and his/her Surety, if applicable) hereby posts this appeal bond in the sum of two hundred and fifty dollars ($250), for his/her appeal of case number ______________. This appeal bond is posted pursuant to the provisions of Tennessee Code Annotated § 16-18-307, and is posted within ten (10) days of the date judgment was entered by the Municipal Court Judge.

The undersigned Defendant hereby appeals this matter to the Circuit Court, and agrees to appear in Circuit Court on the date and time specified by the Circuit Court Clerk.

                                                                                 ____________________________________

                                                                                    Defendant

Received by: ____________________

Date: __________________

For A.D.A. Assistance, please contact: ______________________________ at (_____) ________________________.