SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES PLAINTIFF AND TRIAL COURT CASE NUMBER: DEFENDANT AND RESPONDENT APPELLANT NOTICE OF APPEAL FILED ON: APPELLANT RESPONDENT AFFIDAVIT FOR RELEASE OF FUNDS AND REQUEST FOR PAYMENT OF REPORTER'S TRANSCRIPT ON APPEAL I, __________________________________________, an Official Reporter/Reporter Pro Tempore in the above-entitled action, do hereby certify under penalty of perjury that I have completed and filed with the Clerk of the Superior Court, or sent to the primary reporter, the portion of the Reporter's Transcript on Appeal for which I was the official reporter, and for which a deposit was made in the sum(s) indicated below with said Clerk of the Superior Court. I hereby request payment be made to me in the total sum of $_______________, being the actual amount due to me for the preparation of my portion of said Reporter's Transcript on Appeal for the following and as itemized in the attached page: Original for Court ______ Copy(ies) for Appellant(s) ______ Copy(ies) for Respondent(s) Transcript in computer readable format and media Other: ___________________________________________________________________________________ This payment is to be made from the funds deposited by: Appellant/Counsel ____________________________________________________ Respondent/Counsel __________________________________________________ Other ______________________________________________________________ Other ______________________________________________________________ Amount $__________ Amount $__________ Amount $__________ Amount $__________ Executed on: __________________ CSR #: _______________ Vendor #: ___________________ Invoice #: _______________ Official Reporter Name: _________________________________ ____________________________________________________ [Signature] Address: ____________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Telephone: _________________________________________ E-Mail: ______________________________________________ LA APP 211 (New) LASC Approved XX/12 For Optional Use AFFIDAVIT FOR RELEASE OF FUNDS AND REQUEST FOR PAYMENT OF REPORTER'S TRANSCRIPT ON APPEAL PAGE 1 OF 2 Cal. Rules of Court, rules 8.130 and 8.834 CLEAR SAVE PRINT American LegalNet, Inc. www.FormsWorkFlow.com TRIAL COURT CASE NUMBER: AFFIDAVIT FOR RELEASE OF FEES AND REQUEST FOR PAYMENT OF REPORTER'S TRANSCRIPT ON APPEAL DATE DESCRIPTION (e.g. original transcript, appellant's copy, computer disk, etc.) NOTICE OF APPEAL FILED: # PAGES # FOLIOS PER PAGE $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ AMOUNT TOTAL SEE ADDITIONAL PAGE (if necessary) $ FOR LASC USE ONLY DATE APPROVED: ___________________________________ APPROVED BY: ______________________________________ APPROVER NAME: ___________________________________ LA APP 211 (New) LASC Approved XX/12 For Optional Use AFFIDAVIT FOR RELEASE OF FUNDS AND REQUEST FOR PAYMENT OF REPORTER'S TRANSCRIPT ON APPEAL PAGE 2 OF 2 Cal. Rules of Court, rules 8.130 and 8.834 CLEAR SAVE PRINT American LegalNet, Inc. www.FormsWorkFlow.com