SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BANNING 135 N. Alessandro Rd., Banning, CA 92220 BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 INDIO 46-200 Oasis St., Indio, CA 92201 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) MORENO VALLEY 13800 Heacock St., Ste. D201, Moreno Valley, CA 92553 RIVERSIDE 4050 Main St., Riverside, CA 92501 TEMECULA 41002 County Center Dr., Ste. 100, Temecula, CA 92591 RI-SCL013 FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: Hearing Date: Time: CASE NUMBER: Department: CERTIFICATION OF COSTS ADDED TO JUDGMENT I, , Deputy Clerk for the Judicial District, do hereby certify that on the above entitled case, has filed a cost bill after judgment in the amount of $ and that no motion to tax has been made within the time allowed for making the motion. The levying officer shall include these costs and described in C.C.P. �685.090(c) upon request of this certification. (DATE) (CLERK) I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) Page 1 of 1 Approved for Optional Use Riverside Superior Court RI-SCL013 [Rev.12/5/11] CERTIFICATION OF COSTS ADDED TO JUDGMENT Code of Civil Procedure � 685.090 (c) riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com