DISTRICT COURT OF MARYLAND FOR City/County Located at Court Address Plaintiff/Petitioner Case No. vs. Defendant/Respondent CIVIL APPEAL / REQUEST FOR TRANSCRIPT (APPL) (TRSC) To the Clerk: Please note an appeal in the case referenced above for: Outcome of Motion Hearing Dated Appellant is the Trial Decision Dated Denial of Motion Dated in the said case: . District Court cost of $10 enclosed. (Not applicable to Domestic Violence Appeals.) Advance Circuit Court filing fee and surcharge enclosed: Domestic Violence Case $0 Maryland Second Chance Act Shielding $115 Application for Expungement of Police Records $115 Other $165 (Checks made payable to Circuit Court) Appellant, as an indigent, seeks a waiver of costs. (CC-DC-089 - Request for Waiver of Prepaid Costs / CC-DC-091 - Request for Waiver of Prepaid Costs for Assembling the Record for an Appeal) Appellant is represented by Legal Aid Bureau, Inc., attorney or other eligible legal services corporation, and therefore, exempt from filing fee. My claim amount exceeds $5,000 and I am enclosing a deposit of $75 for the required transcript. NOTE: On appeal, a transcript of the District Court proceeding is required when the claim amount exceeds $5,000 exclusive of interest, costs, and attorney's fees. The cost is $3 per page for an original transcript and one copy. A deposit of $75 is required when the transcript is requested. You will be billed for the balance. The appeal will not be forwarded until all costs, including the cost of the transcript, have been paid in full. Date Fax E-mail Signature of Appellant/Attorney/Attorney Code Printed Name Address City, State, Zip Telephone Number CERTIFICATE OF SERVICE I certify that I served a copy of this motion upon the following party or parties by prepaid hand delivery, on to: Date Name mailing first class mail, postage Address City, State, Zip Name Address City, State, Zip Date Signature of Appellant/Attorney/Attorney Code DC-CV-037 (Rev. 08/2016) American LegalNet, Inc. www.FormsWorkFlow.com