Fill and Sign the Media Request to Photograph Record or Broadcast California Form

NAME OF MEDIA ORGANIZATION: ––––– INDIVIDUAL SUBMITTING REQUEST: ––––– ADDRESS : ––––– ––––– TELEPHONE NO.: ––––– FOR COURT USE ONLY NAME OF COURT: ––––– STREET ADDRESS: ––––– MAILING ADDRESS: ––––– CITY AND ZIP CODE: ––––– BRANCH NAME: ––––– NAME OF JUDGE : ––––– NAME OF CASE : ––––– REQUEST TO CONDUCT FILM AND ELECTRONIC MEDIA COVERAGE AND ORDER CASE NUMBER: ––––– 1. TYPE OF PROCEEDING Criminal (specific charges) : ––––– Civil (specify type, e.g. personal injury, domestic relations, etc.) : ––––– ––––– 2 . PORTION TO BE COVERED (e.g., bail hearing, preliminary hearing, particular witnesses at trial, sentencing hearing): ––––– ––––– 3 DATE OF PROPOSED COVERAGE : ––––– ––––– 4. TYPE OF COVERAGE TV camera and recorder Audio Still camera Other (specify) : ––––– Motion picture camera ––––– ––––– 5 . SPECIAL REQUESTS OR ANTICIPATED PROBLEMS (specify) : ––––– ––––– ––––– CERTIFICATION I certify that if consent is granted to conduct film and electric media coverage in this case, all personnel of this media organization will abide by the provisions of rule 980, California Rules of Court, and any restrictions imposed by the court Date: ––––– ––––– TYPE OR PRINT NAME) (SIGNATURE ) (SUPERVISORY POSITION IN MEDIA ORGANIZATION) ORDER The request to conduct film and electronic media coverage is granted denied granted subject to satisfactory pooling arrangements being made. Date: ––––– (SIGNATURE OF JUDGE) Form Adopted by the Judicial Council of California MC-500 [Rev. January 1, 2007] REQUEST TO CONDUCT FILM AND ELECTRONIC MEDIA COVERAGE AND ORDER Cal. Rules of Court, rule 1.150electronic form ã 1999 WWW.LawCA.co m Law Publishers MC-500