CSD 1533 [04/01/11] UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 REQUEST FOR SERVICES OR EQUIPMENT IN BANKRUPTCY COURT PROCEEDINGS FOR PARTICIPANTS WITH COMMUNICATIONS DISABILITIES Name and address of participant with communications disability Type of participant (juror, witness, attorney) Name and phone number of requestor, if other than the participant (include relationship to participant) Courtroom where services or equipment are required Dept. 1 Dept. 2 Dept. 3 Dept. 4 Dept. 5 Case and Adversary Number, if any (include chapter no.) Date(s) services or equipment are required Type of services or equipment required (include alternate service or equipment information) Interpreter Listening Device Real-Time Reporter* *As a hearing impaired person, I am unable to read lips or understand sign language and require the services of a real-time reporter. I understand that any transcript of the hearing I may need will be at my own expense. Dated: Applicant When requesting interpreter services, please submit this form to either: (by mail) Clerk, U.S. Bankruptcy Court Attn: Courtroom Deputy, Dept. 325 West F Street San Diego, CA 92101-6991 OR (via fax) Courtroom Deputy, Dept. (619) 557-5536 CSD 1533 American LegalNet, Inc. www.FormsWorkFlow.com