Telephone No. Attorney or Party Without Attorney (Name and Address): For Court Use Only Superior Court of California County of Sacramento 720 Ninth Street, Room 102 Sacramento, CA 95814-1380 (916) 874-6868 Plaintiff: Defendant: Rejection of Arbitration Award and Request for Trial de Novo Case Number: NOTICE IS HEREBY GIVEN that parties listed below reject the Award of Arbitrator, dated , and hereby request Trial de Novo in the Superior Court of California, County of Sacramento pursuant to 1141.20 of the Code of Civil Procedure and Rule 1616 of California Rules of Court. Plaintiff(s) Defendant(s) Other (Specify) List all parties you represent that reject the Arbitration Award and request a Trial de Novo: Dated Signature of attorney or party without attorney Proof of Service I served the Trial de Novo by depositing a copy thereof (endorsed in a sealed envelope, postage prepaid) in the United States mail, addressed to each party or their attorney on at , California. At the time of service I was at least 18 years of age, a United States citizen employed/residing in the county where the mailing occurred, and not a party to the action. My residence/business address is: . I declare under penalty of perjury that the foregoing is true and correct and this declaration was executed on at . Dated Local Form Approved for Optional Use C-16 Declarant Trial de Novo American LegalNet, Inc. www.USCourtForms.com