Copy Request Form

Rev. UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY Copies and Associated Fees:Docket Sheets $ .10 per pageElectronically accessible documents $ .10 per pagePaper Records (except Opinions) $ .50 per page Paper Opinions $ .25 per page Certifying $ 11.00 per document Exemplifying $2.00 per document Federal Records Center Retrieval $ 64.00 for the first box; $39.00 for each additional box (the Clerk222s Office will notify you if the retrieval fee applies) PAYMENT IN FULL FOR THE EXACT AMOUNT MUST BE RECEIVED IN ADVANCE. Pay in person atany Divisional Office or mail check or money order with a copy of this form to the Clerk of Court, 601 W.Broadway, Rm 106, Louisville, KY 40202. COPY REQUEST FORMName of individual requesting copies:Case Name: Case Number:Please check below to indicate the type of copies requested. If you want only a docket sheet, check only that box.GDocket SheetGCopies of DocumentsGCertified CopiesGExemplified CopiesIf you are requesting copies of individual documents, please indicate which documents you want copied below.Document(s) Name Document No. Please indicate how you want your copies delivered to you:GI will pick up my copies at the Clerk222s Office upon notification. Please call .GI request the copies be mailed to the following address: .------------------------------------------------------------------------------------------------------------------------------------------------This portion to be completed by Clerk222s Office# electronically accessible pages requested x$.10=# paper record pages requested x$.50=# paper opinion pages requested x$.25=# documents to be certifiedx# documents to be exemplifiedx $11.00=$2.00 = #files to be retrieved from FRCx$64.00 (first box); $39.00 (each additional box) = TOTAL DUEPayment Received by on Request Completed byon American LegalNet, Inc. www.FormsWorkFlow.com