SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-FL011 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PETITIONER: RESPONDENT: CONFIDENTIAL CASE NUMBER: CONFIDENTIAL CONTACT INFORMATION If you would like to receive electronic self-help information about family law services from the court please complete the following: I agree to receive self-help information from the court via email. The email address I want information sent to is: The court values your privacy. At no time will the court make your email address available to any third party. If you would like to stop receiving electronic self-help information from the court please complete the following: I no longer wish to receive self-help information from the court. Please Note: As a party to this action, if you appear without an attorney, you are required to inform the court of any changes in your mailing address and phone number for so long as your case remains active in the court. If you are represented by an attorney, your attorney has an obligation to inform the court of any changes in his or her address and phone number for so long as he or she represents you in this case. 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) Approved for Optional Use Riverside Superior Court Form RI-FL011 [Rev. 1/1/13] CONFIDENTIAL CONTACT INFORMATION riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com