MUNICIPAL COURT FOR THE CITY OF ___________________, TENNESSEE
CITY OF ____________________ CASE # ________________
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.
Received by: ____________________
For A.D.A. Assistance, please contact: ______________________________________ at (_____) ________________________.