NAME AND ADDRESS OF ATTORNEY: TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Central District, 351 North Arrowhead Avenue, San Bernardino, CA 92415-0210 West District, 8303 Haven Avenue, Rancho Cucamonga, CA 91730 Desert District, 14455 Civic Drive, Victorville, CA 92392 North Desert District, 235 East Mountain View, Barstow, CA 92311 PLAINTIFF(S): DEFENDANT(S): CASE NUMBER: MEMORANDUM OF COSTS AND DISBURSEMENTS Claimed by 1. Sheriff's fees $ 2. Clerk's fees $ 3. Reporter's fees: Dates: ; days at $ $ NOTARY FEES Name of Notary: Nature of Document 4. ; fee claimed $ 5. ; fee claimed $ 6. ; fee claimed $ 7. ; fee claimed $ 8. ; fee claimed $ 9. JURY FEES: Dates: ; days at $ $ Jury mileage $ WITNESS FEES AND MILEAGE: Miles Actually Place from Witness Dates in Court Fees Traveled which claimed 10. ; $ ; at 20¢; $ ; $ 11. ; $ ; at 20¢; $ ; $ 12. ; $ ; at 20¢; $ ; $ 13. ; $ ; at 20¢; $ ; $ 14. ; $ ; at 20¢; $ ; $ 15. ; $ ; at 20¢; $ ; $ SERVING PROCESS Miles Served by Persons Served Process Served Traveled Mileage 16. ; ; $ ; @ ¢; $ $ 17. ; ; $ ; @ ¢; $ $ MISCELLANEOUS ITEMS OF COST: $ 18. $ 19. $ 20. $ 21. $ 22. $ TOTAL $ COSTS TAXED BY ORDER OF COURT $ ACIS Code 37040 (OVER) SB-24 15-54-301 Rev. 3/86 2002 © American LegalNet, Inc. Name declares under penalty of perjury that he is attorney/plaintiff/defendant in the above named proceeding, and as such is better informed as to the items charged in the foregoing memorandum and that to the best of his knowledge and belief the foregoing items of cost and disbursements in this action are correct, and that the said disbursements have been necessarily incurred in said action. Declarant Signature Received copy of the within memorandum of costs and disbursements on Signature Attorney for DECLARATION OF SERVICE BY MAIL I hereby declare that I am a citizen of the United States of America, over the age of 18 years, a resident of the abovenamed County and State, and not a part to nor interested in the proceedings named in the title of the within-entitled case. On the date shown below I deposited in the United States Mail at , California, a sealed envelope (postage prepaid) which contained a true copy of the within Memorandum of Costs on Appeal, and which envelope was addressed to the office of the addressee, as follows: Date of Mailing: Document(s) mailed: Name(s) and address(es) At the time of said mailing there was regular communication by mail between the place of mailing and the place so addressed. I declare under penalty of perjury that the foregoing is true and correct. Executed on at , California. Declarant Signature 2002 © American LegalNet, Inc.