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-FL037 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): PETITIONER: RESPONDENT: Hearing Date: Time: CASE NUMBER: Department: STIPULATION AND ORDER ON REQUEST FOR ORDER THE PARTIES HEREBY STIPULATE AND AGREE AS FOLLOWS: (ATTORNEY FOR PETITIONER OR PETITIONER) (ATTORNEY FOR RESPONDENT OR RESPONDENT) SIGNATURE OF PARTIES We have read the entire stipulation and agreement. We understand fully and request the Court to make our stipulation and agreement the Court's order. We understand that willful failure to comply with the provisions of this order will be a contempt of Court and may be punishment by fine and imprisonment. We waive all further notice of this order. (HUSBAND) (WIFE) IT IS SO ORDERED THIS day of , 20 . Judge of the Superior Court Page 1 of 1 Adopted for Optional Use Riverside Superior Court RI-FL037 [Rev. 04/04/13] STIPULATION AND ORDER ON REQUEST FOR ORDER riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com