CIV501 State ENG Rev 2/17www.mncourts.gov/formsPage 1 of 1State of Minnesota District Court County of:Select County Judicial District: Court File Number: Case Type: Plaintiff / Petitioner (first, middle, last) Defendant / Respondent (first, middle, last)vsNotice of Audio/Video Coverage Minn. Gen. R. Prac. 4.03(a)To:County Court Administrator: Trial Judge or Assigned Judicial Officer: Counsel of record: Parties without Counsel: State Court Administrator's Office (Court Information Office)Media Coordinator (List available at www.mncourts.gov) The undersigned media representative provides notice of the intent to cover by audio and/or video means the following district court proceedings (including dates and/or descriptions of the hearing(s) to be covered): NOTE: This form cannot be used for case types listed in Minn. Gen. R. Prac. 4.02(c)(vi). Dated: Signature Name: Media Outlet/ Organization: Address: City/State/Zip: Telephone: E-mail: American LegalNet, Inc. www.FormsWorkFlow.com