Case Information

*0 FILED IN 12th COURT OF APPEALS TYLER, TEXAS 7/17/2015 4:45:49 PM CATHY S. LUSK Clerk *1 T RIAL C OURT O FFICIAL ' EQUEST FOR E XTENSION OF IME TO F ILE R ECORD

Court of Appeals No. (If known): 12 - - -

Trial Court Style:

Trial Court & County: Trial Court No.:

Date Trial Clerk's Record Originally Due:

Date Court Reporter's/Recorder's Record Originally Due:

Anticipated Number of Pages of Record:

I am responsible for preparing a record in this appeal but I am unable to file the record by the original due date for

the following reason/s: (Check all that apply - attach additional pages if necessary.)

o to the best of my knowledge, the Appellant has made no claim of indigence and has failed to either pay

the required fee or to make arrangements to pay the fee for preparing the record.

o my duties listed below preclude working on this record:

o Other. (Explain.) :

I anticipate this record will be completed and forwarded to the 12 Court of Appeals by , and I

hereby request an additional days within which to prepare it. T EX . R. PP . P. 37.3.

In compliance with T EX . R. PP . P. 9.5(e), I certify that a copy of this notice has been served on counsel for all

parties to the trial Court's judgment or order being appealed. I further certify by my signature below that the

information contained in this notice is true and within my personal knowledge.

Date Signature

Office Phone Number Printed Name

___________________________________

E-mail Address (if available) Official Title

Trial Clerk's/Court Reporter's Request for Ext/12 CA-CsL/Tyler/12-3-97 /Rev.5-3-2001 EXAS ULE OF A PPELLATE P ROCEDURE 9.5(e) reads:

Certificate requirements. A certificate of service must be signed by the person who made the service

and must state:

(1) the date and manner of service;

(2) the name and addresses of each person served; and

(3) if the person served is a party's attorney, the name of the party represented by that attorney.

The following parties have been served with a copy of this document:

(Information may be either printed or typed.)

Lead Counsel for A PPELLANT ( S ) : Lead Counsel for A PPELLEE ( S ) :

Name: Name:

Address: Address:

Phone no.: Phone no.:

Attorney for: Attorney for:

Lead Counsel for PPELLANT ( ) : Lead Counsel for PPELLEE ( S ) :

Name: Name:

Address: Address:

Phone no.: Phone no.:

Attorney for: Attorney for:

Additional information, if any: