FOR COURT USE ONLY
(Name, state bar number, and address):

PERSON SUBMITTING REQUEST (name):
ADDRESS:

TELEPHONE NO.:
Insert name of court name of judicial district and branch court, if any:
TITLE OF CASE:
NAME OF JUDGE:
MEDIA NOTICE TO PHOTOGRAPH, RECORD OR BROADCAST
CASE NUMBER:
I. THE PROCEEDINGS MAYBE COVERED (e.g., particular witnesses at trial, the sentencing hearing, etc.):

2. DATE OF COVERAGE (specify):

3. TYPE OF COVERAGE:
a. ÿ TV camera and recorder
b. ÿ Still camera
c. ÿ Motion picture camera
d. ÿ Audio
e. ÿ Other (specify):

Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Amendment IV.
The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

CERTIFICATION

Date: _____________________________ ____________________________________
(TYPE OR PRINT NAME) (SIGNATURE)

Telephone No.: _____________________ ____________________________________
(SUPERVISORY POSITION IN MEDIA AGENCY )

ALL HEARINGS SHALL BE PUBLIC UNLESS FOR IMPEACHMENT:
The Trial of all Crimes, except in Cases of Impeachment; shall be by Jury; and such Trial shall be held in the State where the said Crimes shall have been committed; but when not committed within any State, the Trial shall be at such Place or Places as the Congress may by Law have directed.

Amendment VII.
In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law.
DATE:
TIME:
DEPT./DIV.
ROOM:


MEDIA NOTICE TO PHOTOGRAPH, RECORD OR BROADCAST