ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS) TELEPHONE: FOR COURT USE ONLY ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES PLAINTIFF(S)/PETITIONER(S): DEFENDANT(S)/RESPONDENT(S): CASE NUMBER: DECLARATION AND ORDER RE JURY FEES Declarant states: 1. I am the attorney for (party title and name): following named party (type or print your name): 2. 3. I/we have heretofore deposited jury fees in the amount of $ in this case. . . Prior to January 1, 1998, this case was settled, dismissed, or I/we waived jury in this case, and, if trial was set in this case, the court was notified prior to 2:00 p.m. of the court day preceding the trial date that the prospective or impaneled jurors summoned and/or directed to appear for the following court day, would not be needed for the trial of the case, as required by subdivision (f) of Section 5.0 of the Los Angeles Superior Court Rules. The aforementioned deposited jury fees have not been ordered forfeited or applied as payment for services of jurors and have not been previously ordered refunded in this case. This cause was not set for trial. This cause was set for trial on the following dates (include all continued settings): 4. 5. On all the trial dates listed above in which trial was continued, vacated, or otherwise not held due to settlement or on request of one or more of the parties, the court was notified by 2:00 p.m. of the previous court day that a jury would not be required. 6. This case was not or will not be dismissed after January 1, 1998, and no waiver of trial by jury has occurred in this case on or after that date. DECLARATION AND ORDER RE JURY FEES 12 American LegalNet, Inc. www.USCourtForms.com A refund of the fees deposited as shown in item 2 above is proper because (explain in narrative what happened relative to a jury on each trial date set and continued in this case. e.g. When and how did the court know a jury would not be required on each date set? Was a panel called? Was the jury excused after arriving in the trial department? Did the other side pay any jury fees? See Rule 5.0, subdivision (f) of the Los Angeles Superior Court Rules and Section 27081.5 Government Code.): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (Declarant) (Address) ORDER This matter having been set for trial, the court finds the declarant did did not give adequate notice under Local Rule 5.0, subdivision (f) to the court that jurors would not be needed for the trial of the case. The court finds this matter was dismissed, settled or jury waived on (date) after deposit of jury fees, before after January 1, 1998, the effective date of Section 27081.5 of the Government Code. Good cause appearing, the Clerk is ordered to by him/her/them in the sum of $ Dated: forfeit . refund to the above declarant the jury fees deposited , (Judge/Commissioner) DECLARATION AND ORDER RE JURY FEES American LegalNet, Inc. www.USCourtForms.com