STATE OF NORTH CAROLINA County Name Case File No. Date Of Proceeding(s) Name Of Judge Presiding At Proceeding(s) Courtroom Where Hearing Held In The General Court Of Justice District Court Division In The Matter Of: REQUEST AND ORDER FOR AUTHORIZING TRANSCRIPT OF CONFIDENTIAL PROCEEDING REQUEST I, the undersigned, request the Court to provide a duplicate copy of the audio verbatim recording of the confidential proceeding named above which was electronically recorded. My reason for this request is as follows: NOTE: Record On Appeal Information For preparation of a record of a case on appeal, follow the requirements set out in the Rules of Appellate Procedure, promulgated by the Supreme Court of North Carolina. These Rules describe what is required in the preparation of the record on appeal and the transcript format to be followed. Date Of Request Name Of Person Making Request (Type Or Print) Signature Of Person Making Request Telephone No. Of Person Making Request ORDER It is ordered that the Clerk of Superior Court in the county named above shall duplicate the audio verbatim recording of this matter and provide it to the authorized person named below. No fee shall be charged for any cost of producing the duplicate medium. The following person is authorized by the Court to listen to and transcribe any duplicate recording mediums produced of the verbatim record of the court hearing in the above-named confidential proceeding: Name, Address And Telephone No. Of Authorized Person (Type Or Print) It is further ordered that the authorized person maintain strict confidentiality of the record(s) in accordance with the statutes. This person shall return the duplicate recording mediums of this proceeding to the custody of the Clerk of Superior Court immediately upon the completion of the transcription of this matter. The Clerk, upon receipt of the duplicate of this confidential proceeding, shall erase the duplicate recording mediums. It is further ordered that the authorized person named above shall forward a copy of the transcript to the following persons/parties: Date Order Issued Name Of Presiding Judge (Type or Print) Signature Of Presiding Judge RECEIPT I have received the duplicate of the recording from the Clerk of Superior Court. Date Received Signature Of Authorized Person To Transcribe The duplicate of the recording has been returned to the Clerk Of Superior Court by the authorized person. Date Returned Signature Deputy CSC Clerk Of Superior Court Assistant CSC AOC-G-115, Rev. 2/12 © 2012 Administrative Office of the Courts Original - File American LegalNet, Inc. www.FormsWorkFlow.com