UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH OFFICE OF THE CLERK Coup requests will be processed on a first come, first serve basis and may take up to 5 business days to complete. We apologize for any inconvenience. Requestor’s Name: ____________________________________________________________ Company Name: ____________________________________________________________ Address: ____________________________________________________________ City, State and Zip: ____________________________________________________________ Phone number: _____________________________ Fax number: ______________________ CASE NUMBER: ______________________________________________________ CASE NAME: ______________________________________________________ REQUEST _____ Exemplication ($18.00 per document) _____ Local Rules ($5.00 or $15.00) _____ Federal Record Center Files ($45.00 per shipment) _____ Transcripts _____ Certificate of Good Standing ($15.00) _____ Certification ($9.00 per document) _____ Copy ($.50 per page) Document Name & Number Pages Required _______________________________________________ _____________ _______________________________________________ _____________ _______________________________________________ _____________ _______________________________________________ _____________ Name on Credit Card ____________________________________________________________ Visa, MasterCard or American Express Number: Expiration Date: ___________________ Federal Express #: __________________________________________ ___________________ i:\forms\reqfrm.wpd American LegalNet, Inc. www.USCourtForms.com