ATTORNEY OR PARTY WITHOUT ATTORNEY Telephone No.: E-Mail Address: Attorney For: FOR COURT USE ONLY (Name, State Bar Number, and Address): Fax No.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE 9991 County Farm Road, Riverside, CA 92503 47-671 Oasis Street, Indio, CA 92201 30755-D Auld Road, Ste. 1226, Murrieta, CA 92563 Child’s Name: Case Number: REQUEST FOR HEARING ON JUVENILE RESTITUTION Dispute Hearing Modification Hearing 1. A restitution dispute hearing is being requested by: Minor Minor’s Counsel Other 2. A restitution modification hearing is being requested by: Minor Probation Minor’s Counsel Victim(s) District Attorney Other 3. Reason(s) for dispute/modification of restitution: I understand that I must serve a copy of this request on all parties associated with the case at least 10 days prior to the hearing date. Form JV-510 – Proof of Service Juvenile - must be filed with the clerk’s office prior to the hearing date. Date: (TYPE OR PRINT NAME) (SIGNATURE) A Restitution Hearing has been scheduled as follows: Date of Hearing: Time: Location: Department: Clerk’s Certificate of Service I certify that I am currently employed by the Superior Court of California, County of Riverside, and that I am not a party to this action or proceeding. I handed a copy of this request to the requestor, listed in 1 and/or 2, at the Court on the date below. I certify that I am currently employed by the Superior Court of California, County of Riverside, and that I am not a party to this action or proceeding. In my capacity, I am familiar with the practices and procedures used in connection with the mailing of correspondence. Such correspondence is deposited in the outgoing mail of the Superior Court. Outgoing mail is delivered to and mailed by the United States Postal Service, postage prepaid, the same day in the ordinary course of business. I certify that I mailed the requestor, listed in 1 and/or 2, a copy of the foregoing notice on this date, by depositing said copy as stated above. Date: Court Executive Officer/Clerk By: , deputy clerk Form# RI-J21 (11/30/09) RI-J21 American LegalNet, Inc. www.FormsWorkFlow.com