IN THE DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FOURTH DISTRICT , Appellant(s), Case No.: v. , Appellee(s). REQUEST FOR EMERGENCY TREATMENT Name of party seeking emergency treatment: Title of emergency filing: Nature of the emergency: Date the order at issue was entered: Date of the event that constitutes the basis for requesting emergency treatment, i.e., the deadline: If a stay is sought, please indicate whether there was an application for relief in the lower tribunal and the date and outcome of any ruling on such motion: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com I hereby certify that this request for emergency treatment is made in good faith, and I understand that pursuant to Administrative Order 2014-1, a party or attorney who requests emergency treatment without an objectively reasonable basis for doing so may be sanctioned. Signature: Printed Name: Address: CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing document has been furnished to by on . Signature: Printed Name: Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com