(Rule 14.4)

No. (appellate court)

(SUPREME COURT or COURT OF APPEALS, DIVISION ___)

OF THE STATE OF WASHINGTON

(Title of trial court proceeding )

with parties designated as in ) COST BILL

rule 3.4) )

(Name of party asking for costs), (appellant, petitioner, or respondent), asks that the following costs be awarded:

1. Statutory attorney's fees $

2. Preparation of original and one copy of report of proceedings $

3. Copies of clerk's papers $

4. Transmittal of record on review $

5. Expenses incurred in superseding the decision of the trial court (Identify) $

6. Charges of appellate court clerk for reproduction of briefs, petitions, and motions (Identify and separately state the charge for each.) $

7. Preparing 50 pages of original documents $

8. Filing fee $___

Total $

The above items are expenses allowed as costs by rule 14.3, reasonable expenses actually incurred, and reasonably necessary for review. (Name of party) should pay the costs.

(Date)

_____________________________________

Signature

Attorney for (Appellant, Respondent, or Petitioner)

(Name, address, telephone number, and Washington State Bar Association membership number of attorney)