Application Form For Media Credential Page 2
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1
2For Court Use:
State v. Cashmore 07-C-237890-C
Reset Form
Copies: Court Information, Marshal Division, Court Administration
Credential # _____________________ Photo ID_______________________
Application for Media Credential in State v. Cashmore, et. al., (Simpson)
Prepare this form online, re-save it, then email it along with a .jpg photo to
info@clarkcountycourts.us
Please check one:
Print Reporter
Broadcast Reporter
Crew
Photographer
Other
(please specify)
Provide explanation here
(Please type last name in ALL CAPS)
Name: (LAST, First, Middle Initial)
LAST NAME, First I.
Parent news organization:
News Media Parent
Affiliate/publication if applicable:
Affiliate
Mailing address:
1234 Postal Address, State, Zip
E-mail address:
Phone number:
(123) 555-1234
Name and e-mail address for person court can contact to confirm your position in the
organization:
Name/title:
Boss
E-mail address:
Phone number if e-mail address is not available:
(123) 555-1234
Required information that will not appear on the credential itself:
Date of birth:
01/01/1964
Sex:
F
Weight:
125
Height:
6'10"
Hair color:
Brown
Eye color:
Blue
A 2”x2.5” 150 dpi head/shoulder photo must accompany this application. Larger but not
smaller .jpgs will be accepted. Credentials will not be produced using photos of persons
wearing sunglasses.
Section to be completed at the time credential is picked up. Photo identification will be
required to receive credential.
I certify that the facts contained in this application are true and complete to the best of my
knowledge and understand that, if credentialed, falsified statements on this application will
result in the revocation of credentials. I authorize investigation of all statements contained
herein.
Signature _____________________________________ Date: ____________________
Photo identification_______________________________________________________
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