IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA Plaintiff, vs. Defendant. DOB: APSIN: ATN: ) ) ) ) ) ) ) ) CASE NO. REQUEST AND ORDER FOR Comm. Lic. CR DL/ID: ST: REQUEST (Type or print neatly) CERTIFICATION. I certify that this document and its attachments do not contain (1) the name of a victim of a sexual offense listed in AS 12.61.140 or (2) a residence or business address or telephone number of a victim of or witness to any crime unless it is an address used to identify the place of the crime or it is an address or telephone number in a transcript of a court proceeding and disclosure of the information was ordered by the court. I, Reason: , request that Date Defendant's Mailing Address Prosecutor does does not Defendant's Signature City State ZIP Daytime Phone PROSECUTOR'S REPLY ( not necessary) oppose this request. Reason: Date Hearing ordered. Date: Request granted. Request denied. ORDER Time: Prosecutor's Signature Courtroom: ABA # Date I certify that on a copy of this order was given or sent to: Clerk: CR-770 (10/13)(cs) REQUEST AND ORDER Judge Type or Print Judge's Name Crim. R. 44(f) & Adm. Bull. 53 AS 12.61.110, AS 12.61.130 American LegalNet, Inc. www.FormsWorkFlow.com