Form No. 13-18605-360 Rev.12-2017 CCP 247247 391 - 391.8 VEXATIOUS LITIGANT WORKSHEET DATE RECEIVED: NAME: CASE NUMBER: TO BE FILLED OUT BY THE FILING PARTY: 1.Have you filed any complaint/petition/application or motion (except a discovery motion)in any other county within the past five years? YES NO 2.If you answered yes to Question 1, complete the following (provide all availableinformation): No. FILING DATE CASE NAME CASE NUMBER COU NTY I have filed more than three. (You must add the additional cases on an attachment) 3.Within the past twelve months, has a court denied your Request to Vacate a Pre-filingOrder? YES NO 4.If you answered yes to Question 3, please identify thecourt(s):--------------------------------------------------------------------------------------------------------------------------------------- FOR CLERK USE ONLY ------------------------------------------------------------------------------------------------------------------- Action and Minute Inquiry (;210) and Register of Actions (;240) Attached: YES NO OTHER CASES: CHECKED VEXATIOUS LITIGANT LIST: YES NO APPLICATION IS LISTED BY SAN BERNARDINO COUNTY : YES NO IF LISTED BY ANO THER COUNTY, WHAT COUNTY? NOTES: DATE: CLERK NAME OF JUDGE WHO ISSUED PRE-FILING ORDER: American LegalNet, Inc. www.FormsWorkFlow.com