CD COPY ORDER FORM

COMMONWEALTH OF MASSACHUSETTS
TRIAL COURT

Housing      G
Court
___________
Division

Boston             G
Municipal Ct.
___________
Division

Superior     G
Court
___________
Division

Juvenile      G
Court
___________
Division

District       G
Court
___________
Division

Probate &   G
Family Court
___________
Division

Land      G 
Court

PART I - TO BE COMPLETED BY PERSON PLACING ORDER

N AM E O F PERSO N  PLAC IN G  O R D ER

N AM E O F C ASE

M AILIN G  AD D R ESS &  ZIP C O D E

D O C KET N U M BER  O F C ASE

N U M BER  O F
C O PIES W AN TED
BY  THIS PER SO N

G 1
G 2
G 3

EM AIL AD D R ESS

D ATES O F R EC O R D IN G S W AN TED

PHO N E N O : (         )

M O ST SERIO U S CHARG E IF CR IM IN AL

Is proceeding is presently pending on appeal?

G  Yes; in order that multiple copies may be made
simultaneously whenever possible, I certify that I
have notified all other parties of this request.

G No

If proceeding was not open to the public or its
record has been sealed or impounded: I certify that I
have entered an appearance in this matter as:
    G counsel for ______________________ , party,
    G a party appearing pro se,
and that this copy will be used solely for an appeal,
or to determine whether to appeal, in the same
matter. (Copies of closed proceedings are available to
other persons or for other purposes only upon
motion.)

I agree to observe all restrictions on the use of CD copies found in applicable Rules of the Trial Court

________________________________________________                                      _____________________
                                         SIG N ATU R E O F PERSO N  PLAC IN G  O R D ER                                                                                                                   D ATE

PART II - TO BE COMPLETED BY PERSON RECEIVING ORDER

C O U R T EM PLO Y EE R EC EIV IN G  O R D ER

C O ST W AIV ED  FO R :
G Judge                G D.A.               G Police Prosecutor
G Attorney provided by CPCS       G c. 261, §§ 27A-27G

D ATE O R D ER  R EC EIV ED

D ATE O R D ER  SEN T

G Other: __________________________________ 

PART III - TO BE COMPLETED BY STAFF OF AOTC TAPE DUPLICATION CENTER

R EC EIPT STAM P

C O M M EN TS

D ATE R ETU R N ED  TO  C O U R T

BY

C O ST (including postage)

C D FO R M  2011-09-28