Skip to content
LitigationForms
B 417AMandatory

Notice Of Appeal And Statement Of Election

Federal · United States Courts · Effective December 1, 2023

This form is used to officially notify the court that an appeal is being made and to state the appellant's choice regarding where the appeal should be heard. It requires identifying the person appealing, the court order being appealed, and all other parties involved in the case.

The court describes it as: This is an Official Bankruptcy Form. Official Bankruptcy Forms are approved by the Judicial Conference and must be used under Bankruptcy Rule 9009.

Open the official PDFfrom United States Courts

Where this fits in a case

Appeal

Stage: Appeal

This form is used in bankruptcy cases when a party wishes to appeal a judgment or order. It helps the court understand who is appealing and what the appeal is about.

Either party may file.

Official instructions

How-to guides published by the court for this form.

Common questions

Who should file this form?
The form is for the appellant, which is the person or party starting the appeal. It can be filed by the appellant themselves or by their attorney.
Does this form tell me what I need to do next?
The form asks the appellant to identify the judgment being appealed and to state their election regarding which court will hear the appeal.
Is there a fee mentioned?
The form mentions that if the appellant is a child support creditor and has filed a specific form, no fee is required.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect December 1, 2023.

Related forms

  • B 417B

    Optional Appellee Statement Of Election To Proceed In District Court

    This form is an optional statement used by an appellee in a bankruptcy appeal. It allows the appellee to choose to have their appeal heard by the District Court instead of the Bankruptcy Appellate Panel.

    Mandatory
  • B 424

    Certification to Court of Appeals

    This form is a certification that all parties involved in a bankruptcy case must file with the court. It asks the court to confirm that certain legal requirements for appealing a decision have been met.

    Mandatory
  • B 101

    Voluntary Petition for Individuals Filing for Bankruptcy

    This form is a Voluntary Petition used by individuals to officially start a bankruptcy case. It asks for detailed personal information, including names, addresses, and employment details for both the filing person and their spouse if they are filing together.

    MandatoryFillable PDF
  • B 101A

    Initial Statement About an Eviction Judgment Against You (individuals)

    This form is an official bankruptcy document used to tell the court about an eviction judgment that exists against you. It asks you to certify if you have the right to stay in your home by paying the back rent and if you have given the court a deposit for future rent.

    Mandatory
  • B 101B

    Statement About Payment of an Eviction Judgment Against You (individuals)

    This form is used to tell the court if you have the right to stay in your home by paying your landlord, or if you have already paid the full amount owed in an eviction judgment. It requires you to file it and give a copy to your landlord within 30 days of filing your bankruptcy petition.

    MandatoryFillable PDF
  • B 103A

    Application for Individuals to Pay the Filing Fee in Installments

    This form is an official document used to ask the court for permission to pay the required filing fee for a bankruptcy case over several payments instead of all at once. It asks the filer to propose a payment schedule and acknowledges that the full fee must be paid by a certain time.

    MandatoryFillable PDF
  • B 103B

    Application to Have the Chapter 7 Filing Fee Waived

    This form is an application used to ask the court for permission to waive the filing fee for a Chapter 7 bankruptcy. It asks the filer to provide detailed information about their family's income, monthly expenses, property, and assets.

    MandatoryFillable PDF
  • B 104

    For Individual Chapter 11 Cases: The List of Creditors Who Have the 20 Largest Unsecured Claims Against You Who Are Not Insiders

    This form is for individuals filing for bankruptcy under Chapter 11. It asks the filer to list the 20 largest unsecured debts owed to them by creditors who are not considered 'insiders.'

    MandatoryFillable PDF