Third Court of Appeals

RECEIPT FOR CHECK-OUT RECORD (CLOSED CASES) This is to acknowledge that I have taken receipt of the following items of this record. I understand that I am fully responsible for the care and custodyof these items. These items will be returned no later than the due date shown below. These items were received by me in good condition, properly bound and certified by the appropriate Clerk or Court Reporter if applicable.

Cause Number: 03-05-00469-CV Retention Center No. Name ofCause: TX Dept of Family and Protective Svcs v Jennifer Barlow Items Checked out: SEALED: 1 box of administrative record

Date Items Checked Out: Date Items are due: PERMANENT

Requested By: Attorney: NicholeBJ3«njsPlsHejTgleFSOn Signature: Driver Lie.

BarC^ffrurr umber: Firm/Agency: Administrative Law Division Address: P.O. Box 12548 Phone Number: 512-475-4195 •iit****************************************#************^^ Approved By: Jeff Kyle Dates Items Returned: PERMANENT