DISTRICT CLERK POTTER COUNTY, TEXAS Instructions: complete this form, sign it, and mail it to: District Clerk, Potter County, P. O. Box 9570, Amarillo, TX 79105 or fax with credit card authorization to 806-372-5061 Cost of copies: Certified Copies $1 per page - Uncertified photocopies .50 per page. Fax copies $1.00 per page (can not fax certified copies) REQUEST FOR COPIES Type of case (circle one): Divorce/CivilCase/CriminalCase/Other _________________ CASE NUMBER:_____________________________ (additional $5 fee if the case number is not provided) Names of parties involved in the case: _____________________________________________________ I hereby request the District Clerk of Potter County, Texas to make copies of the following documents: (list the documents on the lines below) ___________________________________________________________________ ============================================================ Complete this section if Clerk is to return copies by MAIL. You must provide a self addressed stamped envelope. Please contact the Civil Department at 806 379-2301, or the Family Department at 806 379-2319 to determine the number of copies. I request (circle one) certified copies at $1 per page or uncertified copies at .50 per page Mail copies to: ________________________________________________ I have enclosed (circle one): a LAW FIRM CHECK, CASHIER'S CHECK, OR MONEY ORDER (no personal checks accepted) in the amount of . Add $ 5.00 as an additional search fee for obtaining the cause number if not provided Total enclosed:____________ Signature__________________________________ date___________ (Note: if the cost of copies is less than $10 you will receive a refund. No refunds will be made in amounts of less than $1.00) ============================================================ Complete this section if Clerk is to FAX copies (certified copies cannot be faxed) Copies by fax may only be provided if payment is authorized to a MasterCard or Visa credit card. The Clerk is authorized to charge the fees for copies/fax/search to my: (circle one) MASTERCARD/Visa Number_____________________ Exp. date_____________Security Code Card Holder’s Name Authorized user signature________________________________ Date_________ Billing Address & Zip Code Telephone Number:____________________ Fax Number:_____________ Billing Address American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com