BANNING 135 N. Alessandro Rd., Banning CA 92220 BLYTHE 265 N. Broadway, Blythe, CA 92225 RIVERSIDE 4050 Main St., Riverside CA 92501 HEMET 880 N. State St., Hemet, CA 92543 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) INDIO 46-200 Oasis St., Indio, CA 92201 MORENO VALLEY 13800 Heacock St., Ste. D201 Moreno Valley, CA 92553 TEMECULA 41002 County Center Dr., Ste. 100 Temecula, CA 92591 RI-021 FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PLAINTIFF: CASE NUMBER: DEFENDANT: PROOF OF SERVICE BY MAIL I, the undersigned, say: I am over the age of eighteen years and not a party to the within action or proceeding; that my residence or business address is , California. That on the day of to which this proof of service by mail is attached. , I served a copy of the paper by depositing said copy enclosed in a sealed envelope with postage hereon fully prepaid, in the United States Postal Service mail box at the City of , California addressed as follows: Executed on: , at , California. (SIGNATURE OF DECLARANT) Page 1 of 1 Form Adopted for Optional Use Riverside Superior Court RI-021 [Rev.11/22/11] PROOF OF SERVICE BY MAIL riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com