UNITED STATES DISTRICT COURT WESTERN DISTRICT OF OKLAHOMA Case Number: Plaintiff(s) REQUEST FOR REFUND OF ELECTRONIC FEES MADE IN ERROR v. Defendant(s) On _________________, I erroneously made a payment using Pay.gov in the above-captioned matter. I am now requesting a refund of the electronic fee made in error. The receipt number from the erroneous transaction is ____________________. Date: Attorney of Record American LegalNet, Inc. www.FormsWorkFlow.com