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IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT __________________ ( ) STATE OF ALASKA ( ) vs. ) ) ) ) ) ) ) )

Plaintiff,

CASE NO. _______________________CR REQUEST AND ORDER FOR ____________________________

Defendant.

REQUEST (Type or print neatly)
CERTIFICATION. I certify that this document and its attachments do not contain (1) the name of a victim of a sexual offense listed in AS 12.61.140 or (2) a residence or business address or telephone number of a victim of or witness to any crime unless it is an address used to identify the place of the crime or it is an address or telephone number in a transcript of a court proceeding and disclosure of the information was ordered by the court.

I, Reason:

, request that

Date Defendant's Signature ____________________________________________________________________________________ Defendant's Mailing Address City State ZIP Daytime Phone Prosecutor does PROSECUTOR'S REPLY ( does not oppose this request. Reason: not necessary)

Date Hearing ordered. Date: Request granted. Request denied. ORDER Time:

Prosecutor's Signature Courtroom:

Date
I certify that on ______________________ a copy of this order was given or sent to: Clerk: _____________

Judge Type or Print Judge's Name

CR-770 (3/00)(st.3) REQUEST AND ORDER

Crim. R. 44(f) & Adm. Bull. 53 AS 12.61.110, AS 12.61.130