For Court Use Only

(Ver.: 4/2026)

Docket Number: ___ Date of Request: ___

Case Caption:

Date of Hearing:

Name of Requestor:

Address/Phone/Fax # of Requestor:

Email of Requestor:

Are the costs waived or reduced? ☐ Yes ☐ No Is the cost of the transcript being shared between parties? ☐ Yes ☐ No

Original; Ordinary, party $2.50 per page x pages = $

Original; Ordinary, party; Requestor Copy of Original Transcript-Electronic $0.50 per page x pages = $

Original; Ordinary, party; Requestor Copy of Original Transcript-Paper $0.75 per page x pages = $

Original; Ordinary, Commonwealth/sub-division $1.55 per page x pages = $

Original; Ordinary, Commonwealth/sub-division; Requestor Copy of Original Transcript-Electronic $0.50 per page x pages = $

Original; Ordinary, Commonwealth/sub-division; Requestor Copy of Original Transcript-Paper $0.75 per page x pages = $

☐ Expedited ☐ Daily ☐ Same Day per page xpages =

Original; Expedited/Daily/Same Day; Requestor Copy of Original Transcript-Electronic per page xpages =

Original; Expedited/Daily/Same Day; Requestor Copy of Original Transcript-Paper per page xpages =

Existing Transcript Copy-Electronic $0.50 per page x pages = $

Existing Transcript Copy-Paper $0.75 per page x pages = $

Additional Charges xpages =

NOTES Estimated Cost $

Less deposit - $

Balance due = $

Adjusted Cost (+/-) $

Final Balance = $

Transcript to be prepared by: Date assigned: Date due:

Date of deposit: Check/M.O. number Date transcript completed:

Date balance received: Check/M.O. number: Date transcript sent to requesting part(ies):