BILL OF COSTS

(SUPREME COURT)
(Caption and Title)
BILL OF COSTS

DECISION having been rendered in the above-entitled case in favor of plaintiff-

appellant with costs in both instances, the undersigned attorney hereby presents the
following bill of costs to be included in the judgment to be entered:

Regional Trial Court

Here state items of costs claimed.
Supreme Court
Here state items of costs claimed.
(Venue, date, signature)

(Verification)

(Notice of Hearing)