Sample Notice of Appeal. Notice Of Appeal To District Court. Files.Notice Of Appeal To District Court. Write down everything you know about the decision. Write down why it should be reconsidered. The example reflected below is a typical motion in the appellate court. Send the letter directly to the office, department or individuals involved in the situation. Simply sending the letter to the ombudsman is not appropriate. A sample notice of appeal can be found on the Office of. The tenant must fill out and sign the Certificate of Service section on the back of the Notice of Appeal form.