SUPERIOR COURT, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA BANNING 155 E. Hays, Banning, CA 92222 BLYTHE 265 North Broadway, Blythe, CA 92225 CORONA 505 Buena Vista, Corona, CA 91720-1997 HEMET 880 N. State St., Hemet, CA 92543 INDIO 46-200 Oasis St., Indio, CA 92201 LAKE ELSINORE 117 S. Langstaff, Lake Elsinore, CA 92530 MORENO VALLEY 13800 Heacock Ave. D201, Moreno Valley, CA 92553-3338 PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 PERRIS 227 N. "D" St., Perris, CA 92570 RIVERSIDE 4050 Main St., Riverside, CA 92501 TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 Plaintiff CASE NO. VS DECLARATION (Section 170.6 CCP) Defendant DECLARES: in this action. That he/she is the , Judge/Commissioner of the above entitled court before That whom the trial of the aforesaid action is assigned, is prejudiced against the party or the interests of said party so that the party cannot, or he/she believes that he/she cannot have a fair and impartial trial or hearing before said Judge/Commissioner. I declare under penalty of perjury that the foregoing is true and correct. , at Date: , California. SIGNATURE OF DECLARANT SCL006 [11/95] DECLARATION (Section 170.6 CCP) RISCL006 2001 © American LegalNet, Inc.