*1

RECORDS REQUEST FORM

9/16/15

Name: Cheryt Amich

Firm: Laue $066\underset{―}{\text{Cheryt Amicen}}$ Phone #: 817-475-3034

RECORDS TO BE COPIED: (check all that apply)

Cik. Record $◻$ Rep. Record $◻$

Other:

DO NOT FILL OUT BELOW THIS LINE: FOR OFFICE USE ONLY. Clerk: $$ $\mathbf{8}\mathbf{6}$ check if this is party's first complimentary copy.