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SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE RI-MC010 PARTY / ATTORNEY / AGENCY (Name and Address) FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): FAX NO. (Optional): CASE NUMBER: I am filing the attached document with the Riverside Superior Court. Date: By: (TYPE OR PRINT YOUR NAME) (SIGNATURE) Approved for Optional Use Riverside Superior Court RI-MC010 [Rev. 03/25/16] riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1