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									                COWLITZ COUNTY SUPERIOR COURT VIDEO DISK ORDER FORM

TO :    Cowlitz County Superior Court                 ORDER DATE:
        312 SW First Avenue
        Kelso, WA 98626                               REQUESTED DUE DATE:
        360.414.5543 (Danyel Whipkey)
        whipkeyd@co.cowlitz.wa.us
        360.577.3070 (Gayle Engkraf)
        engkrafg@co.cowlitz.wa.us
        360.577.3155 (Alice Millward)
        millwarda@co.cowlitz.wa.us

CASE NAME:

Cowlitz County Cause No.:

Ordered By:

Company / Firm:

Address:



Phone:                                                               Amount Paid: $

        Payment must accompany this form. The cost for each cd / dvd is $25.00.
        (Only one day can be burned onto a disk; multiple-day requests are charged $25 for each day.)

   We only accept Cash or Money Orders made payable to: Cowlitz County Clerk

 Qty.            Proceeding Type                    Proceeding Date & Time            Courtroom Number
               (hearing / docket / trial, etc.)                                              (1, 2, 3, etc.)




Please Note: If this form is not completely and accurately filled out, your request may be
significantly delayed or not processed at all. If necessary, you may be charged an additional $25
research fee. (The clerk’s file contains this information, which may be accessed upon request.)

             ORDERS WILL GENERALLY BE COMPLETED IN 1 to 2 BUSINESS DAYS.

 Cowlitz County Superior Court ~ Hall of Justice ~ 312 SW First Avenue ~ Kelso, WA 98626
                          360.577.3085 ~ TDD Phone 360.577.3061


                                                  For Office Use Only:
Received:                        Payment:                      Completed:              By:

								
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