Texas Fax Filing Cover Sheet (potter County)

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					                                    DISTRICT CLERK

                               POTTER COUNTY, TEXAS



(Instructions: PLEASE PRINT CLEARLY--complete this form, sign it, and fax it to
District Clerk FAX 806-372-5061)

                              FAX FILING COVER SHEET

FROM:______________________________________ Date___________________



Number of pages including this cover sheet_______________



Please file the following law suit styled:
_______________________________________________________________

(style of the suit must be provided)
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(Complete this section only if citations are to be issued upon filing of the new suit):

Please issue citations to the defendant/s and

_______return citation/s by mail to (address) _______________________________
_______deliver citation/s to Potter County Sheriff for service.

=============================================================

Please charge applicable fees to my (circle one) Mastercard Visa credit card.

Credit card number______________________Expiration date___________________

Cardholder's name______________________________________________________



Signature of requestor:___________________________________________________

Telephone number of requestor___________________ Fax number_______________

For clerk's use only: amount of charge$__________ref. #________processed by______