SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BANNING 311 E. Ramsey St ., Banning, CA 92220 MURRIETA 30755 - D Auld Rd., Murrieta, CA 92563 BLYTHE 265 N. Broadway, Blythe, CA 92225 PALM SPRINGS 3255 E. Tahquitz Canyon Way, Palm Springs, CA 92262 CORONA 505 S. Buena Vista, Rm. 201, Corona, CA 92882 RIVERSIDE 4100 Main St. Riverside, CA 92501 HEMET 880 N. State St., Hemet, CA 92543 RIVERSIDE 4175 Main St., Riverside, CA 92501 INDIO 46 - 200 Oasis St., Indio, CA 92201 RIVERSIDE 4050 Main St., Riverside, CA 92501 INDIO 47 - 671 Oasis St., Indio, CA 92201 RIVERSIDE 9991 County Farm Rd., Riverside, CA 92503 MORENO VALLEY 13800 Heacock St., Ste. D201, Moreno Valley, CA 92553 TEMECULA 41002 County Center Dr., Ste. 100, Temecula, CA 92591 RI - MC005 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address ) FOR COURT USE ONLY TELEPHONE NO: FAX NO. (Optional): E - MAIL ADDRESS (Optional): ATTORNEY FOR (Name ): PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER : FACSIMILE TRANSMISSION COVER SHEET TO THE COURT: 1. Please file the following transmitted documents in the order listed below: Document Name No. of Pages 2. Processing instructions consisting of: pages are also attached. 3. Conformed Copies I am providing an email address above and request the conformed copy be emailed. I do not require a conformed copy. Charge the credit card listed in #4 for an envelope/postage; mail conformed c opies to the address noted above. 4. Fees Required Fax Filing Fees (Check only one box) : I am a Fax Filing User with the Riverside Superior Court and have paid my annual registration fee. My Bar # or fax registration account # is: . or I am fax filing the above listed document(s) at $ 2.00 per page and my credit card information is listed below. NOTE: If you are not an annual registered user, by default, the court will charge $ 2.00 per page to fax file. Filing Fees : Filing Fees owed pursuant to the Riverside Superior Court Fee Schedule shall be charged to the credit card listed below. Credit Card Payment I authorize charges for the above fees and any amount imposed by the card issuer or draft purchaser to be charged to the following account: VISA MASTERCARD DISCOV ER AMERICAN EXPRESS Account No.: Expiration date: (TYPE OR PRINT NAME OF CARDHOLDER ) (SIGNATURE OF CARDHOLDER ) Page 1 of 1 Adopted for Mandatory Use Riverside Superior Court RI - MC005 [Rev. 07/01/16 ] FACSIMILE TRANSMISSION COVER SHEET r iverside.courts.ca.gov/localfrms/loca l frms.shtml American LegalNet, Inc. www.FormsWorkFlow.com