FORM STATEMENT OF ADDITIONAL GROUNDS FOR REVIEW

STATE OF WASHINGTON )

)

Respondent, )

) No.________________________

v. )

) STATEMENT OF ADDITIONAL

______________________ ) GROUNDS FOR REVIEW

(your name) )

)

Appellant. )

I, _____________________, have received and reviewed the opening brief prepared by my attorney. Summarized below are the additional grounds for review that are not addressed in that brief. I understand the Court will review this Statement of Additional Grounds for Review when my appeal is considered on the merits.

Additional Ground 1

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Additional Ground 2

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

If there are additional grounds, a brief summary is attached to this statement.

Date:______________________ Signature:________________________

[December 24, 2002]