SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BANNING 311 E. Ramsey St ., Banning, CA 92220 MURRIETA 30755 - D Auld Rd., Ste. 1226, Murrieta, CA 92563 BLYTHE 265 N. Broadway, Blythe, CA 92225 PALM SPRINGS 3255 E. Tahquitz Canyon Way, Palm Springs, CA. 92262 HEMET 880 N. State St., Hemet, CA 92543 RIVERSIDE 4050 Main St., Riverside, CA 92501 INDIO 46 - 200 Oasis St., Indio, CA 92 201 TEMECULA 41002 County Center Dr., Ste. 100, Temecula, CA 92591 MORENO VALLEY 13800 Heacock St., Ste. D201, Moreno Valley, CA 92553 RI - MC006 ATTORNEY OR PARTY WITHOUT ATTORNEY ( Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO: FAX NO. (Optional): E - MAIL ADDRESS (Optional): ATTORNEY FOR (Name ): PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER ( IF APPLICABLE ) : REQ UEST FOR REFUND OF FILING FEES COURT REPORTER FEES JURY FEES PROBATE INVESTIGATOR FEES COURT ORDERED CASH BOND RETURNED OTHER I am requesting a refund in the amount of $ . Reason(s): Date of payment/deposit: Amount Paid: $ Receipt # : Depositor (printed name): Address: (NUMBER) (STREET) (CITY) (STATE) (ZIP ) Type of credit card: American Express Discover Master C a rd Visa Last four digits of card number: Date: Signature: TO BE COMPLETED BY COURT Request for refund: Approved Denied Date: By: P age 1 of 1 Approved for Optional Use Riverside Superior Court RI - MC 00 6 [Rev. 01/03/18 ] R EQUEST FOR REFUND riverside.courts.ca.gov/localfrms/loc a lfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com