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State of Hawai'i
Circuit Court of the First ( ) Second ( ) Third ( ) Fifth ( ) Plaintiff

REQUEST FOR TRANSCRIPT OF
PROCEEDINGS FOR RECORD ON APPEAL

Case Number

vs.

Defendant

In connection with the Notice of Appeal filed in this case on the date indicated, the below listed official court reporter is requested to prepare and furnish in the regular order of cases tried a transcript of the proceedings of this case held on the date indicated. Pursuant to HRAP Rule 10(b)(1)(D), appellant is responsible for serving a filed copy of this Request for Transcript upon the official court reporter. Date Notice of Appeal Filed Specify Portions of Transcript Requested

RECORDED BY:

[

] Court Reporter

[

] Videotape

[

] Audiotape

Name of Court Reporter Requested to Prepare Transcript or if Audio/Video, Supervising Court Reporter Reporter's Name Date of Proceeding(s)

NOTE: THOSE EXCEPTED BY HRS, SEC 606-13 MAY DISREGARD THE FOLLOWING PARAGRAPH: In accordance with HRS Section 606-13 and HRAP Rule 10(b)(1)(B)(ii), a deposit will be made with the Chief Clerk of this circuit satisfactory to the official court reporter or a prepayment made to the official court reporter within 10 days to insure payment on completion of the requested transcript. Upon completion and certification of the transcript by the official court reporter, the clerk shall pay the court reporter the fees earned from the deposit. Excess fees shall be returned to the depositor.

Date of request: _________________________________

Attorney for: Plaintiff ____ Signature:

Defendant ____

Name Firm Address Deposit/Prepayment made: Yes Phone No. No

Date

RECEIPT OF REQUEST FOR TRANSCRIPT ACKNOWLEDGED: Signature Estimated Completion Date