Criminal Records Copies Request {CR-114}

Local Court Form 226 Mandatory CR-114 Rev 4/3/19 Superior Court of California, County of Contra Costa MARTINEZ 725 COURT STREET MARTINEZ, CA 94553 PITTSBURG 1000 CENTER DRIVE PITTSBURG, CA 94565 RICHMOND 100 37th STREET RICHMOND, CA 94805 CRIMINAL RECORDS COPIES REQUEST This form is used to request for copies of criminal records by mail and to pay by credit card. DO NOT PROVIDE CREDIT CARD INFORMATION BY E-MAIL, FACIMILE, OR PHONE. You may submit a standalone completed form or attach a signed form with credit card information filled in to your request letter. Copies are $.50 per page. If certification is requested, an additional fee of $25.00 per document is required. There is also a service fee of 2.99% added to each docket number requested. The minimum service fee is $1 per docket number requested. Include a self-addressed stamped envelope. A receipt will be returned to you with any requested copies. This form is not required for payment by check. Include a self-addressed stamped envelope and a check with an appropriate do not exceed amount made payable to 223Contra Costa Superior Court224 with your request letter. Requestor222s Name: Telephone Number: Name to be searched: Docket No: Date of Birth: Driver222s License No: Type of copies: Regular Certified Types of Records Requested: (For multiple requests, attach a list to this form with the identifying information indicated above.) Credit card payment information: Visa MasterCard Discover Card # CVV: Exp Date: Cardholder222s Name (as it appears on card): Cardholder222s Billing Address: Mailing Address (if different from billing address): E-mail Address (optional for e-mail receipt): I authorize Contra Costa Superior Court to charge my credit card XXXX - XXXX - XXXX - Pa yment Authorization Signature Date Last 4 digits of credit card COURT USE ONLY Copies Made No Copies Made Docket Number(s): Amount Charged (exclude service fee): Date Charged: American LegalNet, Inc. www.FormsWorkFlow.com