FORM 3. COURT REPORTER STATEMENT Circuit Court No. Appellant vs. Appeal No. Respondent TO THE MISSOURI COURT OF APPEALS, WESTERN DISTRICT: In support of the appellant’s motion for an extension of time to file the transcript on appeal in the above case, I hereby certify and represent to the Court: 1) that I served as the official court reporter in the trial of the above case which ended on (date of judgment) . 2) that within 10 days after the filing of the appellant’s notice of appeal, the appellant gave me a written order for such transcript; (if not ordered within 10 days, state when transcript ) was ordered 3) that appellant made a sufficient deposit for the transcript on (date) (or was allowed to appeal in forma pauperis); 4) that appellant has not countermanded said order nor has he requested me to defer to delay my preparation of said transcript; 5) that I have not prepared said transcript within the time required because (If the delay is caused by the fact that transcripts are being prepared in other cases on appeal, list those cases, approximate number of pages of the transcript and the approximate date of completion. If the delay is caused by circumstances other than workload occasioned by the preparation of other transcripts, those circumstances must be stated with particularity and mere conclusions will not suffice. Compliance with this paragraph is mandatory.) 6) that I will complete the preparation of the transcript on appeal in this case on or before 7) that I have delivered, on this date, a copy of this statement to my supervising judge, the Honorable . Date Official Court Reporter (Court) (Office) (Home) (Amended effective Nov. 25, 1981; amended Dec. 18, 2003; effective April 1, 2004) Phone number of Court Reporter American LegalNet, Inc. www.USCourtForms.com