SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BANNING M ORENO VALLEY BLYTHE MURRIETA CORONA PALM SPRINGS HEMET RIVERSIDE RI - ADR12 Name, State Bar N umber and Address) FOR COURT USE ONLY (Optional): (Optional): (Name Proof of Service of Statement of Agreement/Nonagreement By Mail, Fax, or Electronic Service STATEMENT OF AGREEMENT/NONAGREEMENT Statement of Agreement/Nonagreement Names Fax Numbers Page 1 of 2 Proof of Service of Statement of Agreement/Nonagreement By Mail, Fax, or Electronic Service American LegalNet, Inc. www.FormsWorkFlow.com Names E - mail Addresses Page 2 of 2 Proof of Service of Statement of Agreement/Nonagreemen t by Mail, Fax, or Electronic Service American LegalNet, Inc. www.FormsWorkFlow.com