Prepare Fax Filing Cover Sheet

Docket Number:  

Case Style:  

Title of Document:  

Attorney:  First Name:    Last Name:  

Attorney's Address:  

Attorney's City:  

Attorney's State:    Zip:  

Attorney's Phone Number:    Attorney's Fax Number:  

Email Address:  

Re-enter Email Address:  

Date Faxed:  

Total pages, including cover page:    (Cannot exceed 50 pages unless authorized by Court.)

Your service charge pursuant to T.R.C.P 5A.04 is $