SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BLYTHE 265 N. Broadway, Blythe, CA 92225 HEMET 880 N. State St., Hemet, CA 92543 INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4175 Main St., Riverside, CA 92501 RI-FL016 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PROTECTED PARTY: RESTRAINED PARTY: CASE NUMBER: REQUEST TO DISMISS DOMESTIC VIOLENCE RESTRAINING ORDER The Protected Party is requesting that the Domestic Violence Restraining Order filed on be terminated and dismissed for the following reason(s): and granted on Additional Information is continued on attachment. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF THE PROTECTED PARTY) Identification of the Protected Party The Court makes the following Order(s): Request for Dismissal Granted Other: Date: was verified ORDER was not verified by the clerk. (CLERK) Set for Hearing (DATE/TIME/DEPARTMENT) (JUDICIAL OFFICER) Page 1 of 1 Approved for Mandatory Use Riverside Superior Court RI-FL016 [Rev. 01/01/14] REQUEST TO DISMISS DOMESTIC VIOLENCE RESTRAINING ORDER Local Rule 5141 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com