Form App. R. 10-3 Clerk's Verified Motion For Extension Of Time To Assemble Clerk's Record IN THE INDIANA [SUPREME COURT OR COURT OF APPEALS] Case No.: __________________________ [insert Supreme Court or Court of Appeals number, if known] ) ) ) ) ) ) ) ) ) ) Appeal from the ________________ Court Trial Court Case No: ____________________ The Honorable ________________, Judge ______________________, Appellant(s), vs. _____________________, Appellee(s), CLERK'S VERIFIED MOTION FOR EXTENSION OF TIME TO ASSEMBLE CLERK'S RECORD __________________________, the clerk of __________________ court, being first duly sworn upon his/her oath, respectfully petitions the Court for an extension of time in which to prepare the clerk's record in this appeal. In support of this Motion, the clerk shows the Court as follows: 1. 2. The Appellant filed a Notice of Appeal on __________________, 20__. Pursuant to Appellate Rule 10(B), the clerk's record is due to be assembled thirty days after the Notice of Appeal is filed. Unless this Motion is granted, the record assembly must be completed, and the Notice of Completion of Clerk's Record must be issued no later than ___________________, 20__. American LegalNet, Inc. www.FormsWorkFlow.com 3. This clerk respectfully requests an enlargement of time of ________ (____) days, to and including ______________, ______, in order to assemble the clerk's record and issue its Notice of Completion. 4. An extension of time is needed because: (state reasons specifically including case names and cause numbers) _____________________________________________________________________________ _____________________________________________________________________________ ____________________________________________________________________________. 5. This is the (first/second/third) Verified Motion for Extension of Time to Assemble Clerk's Record. WHEREFORE, _______________________, clerk for ___________ court respectfully requests an extension of time of _____________ (_____) days within which to assemble the clerk's record and issue its Notice of Completion of Clerk's Record to _________________, 20__. I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. __________________________________________ Clerk, _____________________ Court CERTIFICATE OF SERVICE I certify that on [insert date] I served a copy of this document upon the following person(s) by [specify means of service]: [Separately list name(s) and address(es) of person(s) served] __________________________________ Clerk 2 American LegalNet, Inc. www.FormsWorkFlow.com