ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address) : FOR COURT USE ONLY Telephone No.: E -Mail Address (Optional): ATTORNEY FOR (Name): Fax No. (Optional): Bar No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Civil Complex Center - 751 W. Santa Ana Blvd., Santa Ana, CA 92701-4512 Harbor- Newport Beach Facility - 4601 Jamboree Rd., Newport Beach, CA 92660-2595 North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 CASE NUMBER: PLAINTIFF / PETITIONER: DEFENDANT / RESPONDENT: APPLICATION AND ORDER FOR ELECTRONIC FILING AND SERVICE EXEMPTION 1. Case assigned to: Judicial Officer: Department: Date complaint filed: I, (name of applicant) ________________________________, request to be exempt from the electronic filing and service requirement on the above case for the following reasons: a. I do not readily have access to a computer with Internet access. b. Mandatory electronic filing would cause undue hardship or significant prejudice because ________________________________________________________________________________________________ ________________________________________________________________________________________________ c. Other (please specify): __________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: _________ _________________________________ (TYPE OR PRINT NAME) _________________________________ (SIGNATURE OF DECLARANT) DECLARATION OF SERVICE BY MAIL I am at least 18 years of age and not a party to this legal action. I deposited the Application for Electronic Filing and Service Exemption in a sealed envelope with postage fully prepaid, addressed as listed below. I am a resident of or employed in the county where the mailing occurred. My residence or business address is: ____________________________________________ Date of mailing:______________________________ Place of mailing (city and state):__________________________________ List of names and addresses continued in attachment. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: _________ _________________________________ (TYPE OR PRINT NAME) _________________________________ (SIGNATURE OF DECLARANT) Approved for Optional Use L0021 (Rev. Dec. 2016) American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION AND ORDER FOR ELECTRONIC FILING AND SERVICE EXEMPTION CRC 2.253(c) www.occourts.org PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: ORDER The court has reviewed this application and makes the following orders: 1. The court grants the application for exemption from electronic filing and service. Pursuant to CRC 2.253(c), the court is allowing the applicant to serve, file, or serve and file all documents in the above mentioned case number in paper form. The court denies the application for exemption because of the following reason(s): ______________________________________________________________________________________________ ______________________________________________________________________________________________ 3. The court needs more information to decide whether to grant the application. The applicant must appear in court on the date below: 2. NOTICE OF HEARING Date: Location: Dated: Clerk's Certificate of Service I certify that I am not a party to this action and (check one): A certificate of mailing is attached. I handed a copy of this order to the applicant listed above, at the court, on the date below. This order was mailed first class, postage paid, to the applicant at the address listed above, from (city): , California on the date below. Time: Dept.: Judge/Commissioner Dated:_________________________ DAVID H. YAMASAKI, Clerk of the Court By: __________________________ Deputy Clerk Approved for Optional Use L0021 (Rev. Dec. 2016) APPLICATION AND ORDER FOR ELECTRONIC FILING AND SERVICE EXEMPTION CRC 2.253(c) www.occourts.org American LegalNet, Inc. www.FormsWorkFlow.com