TRANSMITTAL OF AGENCY RECORD TO: Superior Court Clerk (Court Address) Date: FROM: (Name of Agency) (Name of Person at Agency) (Address) RE: Case Name: Appeal Case Number: Agency Case Number: CI Pagination of the agency file has been completed. In accordance with Appellate Rule 604(b)(1)(B)(ii) and (iii), the following items are being forwarded to you: volumes of agency file (a copy) The file is numbered from page _______ to _______. ____ volumes of transcript (original) ____ volumes of depositions (copies) ____ list of exhibits being forwarded (List only those not included in in the agency file.) ____ envelopes/boxes containing exhibits ____ list of exhibits retained by agency ____ other: ____ If the court needs any of the exhibits being retained by the agency, the court must contact the following person: Name: Title: Phone No. Date Location: Agency Representative AP-312 (3/01)(cs) TRANSMITTAL OF AGENCY RECORD American LegalNet, Inc. www.USCourtForms.com