FAX FILING COVER SHEET DISTRICT CLERK, POTTER COUNTY, TEXAS Number of pages including this cover sheet_______________ (Instructions: PLEASE PRINT CLEARLY--complete this form, sign it, and fax it to District Clerk FAX 806-372-5061) FROM: Date Please file the following law suit Styled: Complete this section only if citations are to be issued upon filing of the new suit: Please issue citations to the defendant/s and ( )Return citation/s by mail to (address) ( )Deliver citation/s to Potter County Sheriff for service. Please charge applicable fees to my (circle one) Mastercard/Visa, American Express, Discover credit card. Credit Card Number Expiration Date Security Code Cardholder's name Billing Address Signature of requestor: Telephone number of requestor Fax number For clerk's use only: amount of charge$ Ref. # Processed By American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com