IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) ) Appellant (person bringing appeal) vs. APPEAL CASE NO. REQUEST FOR APPROVAL OF SUPERSEDEAS BOND IN AN ADMINISTRATIVE APPEAL CI Appellee REQUEST I am submitting a supersedeas bond in the amount of $ in the form of a cash deposit surety bond. I request that this supersedeas bond be approved. Date I certify that on a copy of this request and the bond were mailed hand-delivered to (list names): Signature of Appellant Print Name and Title (if applicable) Mailing Address City By: Home Phone ORDER Request to approve supersedeas bond is granted. Pursuant to Appellate Rule 603(a)(2), the judgment in this case is stayed for the duration of the appeal. Request to approve supersedeas bond is denied. Reasons: State Work Phone ZIP Date I certify that on a copy of this order was sent to (list names): Administrative Agency Appellant Attorney General Clerk: AP-115 (2/12)(cs) REQUEST FOR APPROVAL OF SUPERSEDEAS BOND IN AN ADMINISTRATIVE APPEAL Judge/Clerk* Type or Print Name *Clerk may sign only those orders authorized by Appellate Rule 603(a)(2)[e]. App. R. 603 American LegalNet, Inc. www.FormsWorkFlow.com