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-FL036 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PETITIONER: RESPONDENT: CASE NUMBER: DECLARATION OF RESIDENCE The undersigned certifies that this case should be tried or heard in the: Blythe Court for the following reasons: The party's primary residence is located within the geographical area. The city and zip code is: City Other: Zip Code Hemet Court Indio Court Riverside Court 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 Adopted for Mandatory Use Riverside Superior Court RI-FL036 [Rev. 01/01/13] DECLARATION OF RESIDENCE Local Rule 5101 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com