County Clerk “Copy Request” Cover Sheet
Page of
(Please use a separate form for each case / cause #)
Date:
To: Denton County Clerk, Juli Luke
Department: Civil Clerk Fax: (940) 349-5215 / Email: countyclerkcivil@dentoncounty.com
From Name: ________________________________ Firm:_____________________________________
Phone #: (____) ________-________ (required)
Business Check:
Business Name: _________________________________________________________________________
Mailing Address: __________________________________ City ________State______ ZIP___________
Business Phone #: ( ) ______-_______ Phone #: ( ) ______-_______
Driver’s License # _________________________ Issuing State ________ Date of Birth ____/_____/_____
Routing #. ______________________ Account # ____________________ Check # ___________________
Email Address___________________________________________________________________________
**Providing an email address will allow your receipt to be emailed to you. **
Authorized Signature: ______________________________________________________
This form authorizes the Merchant (LexisNexis Payment Solutions) to charge my account, for services rendered by the County Clerk’s Office, plus a
$2.50 service fee. Also, authorizing the Merchant to convert their check to an Electronic Funds Transfer or Paper Draft, and to debit their account for the
total transaction amount event that the draft or EFT is returned unpaid, the Customer agrees that a fee of $30.00 or as allowable by law may be charged
to their account via draft or EFT.
Once this request is completed, it cannot be cancelled because the funds are guaranteed. If the customer has any questions regarding this
authorization, they may contact Customer Service at 866-255-1857.
Case / Cause #: ________________________ Defendant’s Name: ______________________
Please list documents:
After we receive the request, our office has a 10-day turnaround.
□ Certified Copies □ Mailed Plain Copies
□ Clerks Certificate
* Electronic Plain Copies – Must Use Email Request Form
Document Title Date Document Filed
_______________________________________________________________________ ____________________________________________
_______________________________________________________________________ ____________________________________________
_______________________________________________________________________ ____________________________________________
_______________________________________________________________________ ____________________________________________
Certified Copies $5.00 per document + $1.00 per additional page (certified copies will be mailed back to the address listed
above)
Clerk’s Certificate $5.00 per cert. + $1.00 per additional page
Plain Copy $1.00 per page (plain copies will mailed to the address listed above.)
