Attorney or Party without Attorney ( Name, Address and Telephone number) For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Barstow District, 235 East Mountain View, Barstow, CA 92311 Fontana District, 17780 Arrow Blvd, Fontana, 92335 Joshua Tree District, 6527 White Feather Road, Joshua Tree, CA 92252 Rancho Cucamonga District, 8303 Haven Avenue, Rancho Cucamonga, CA 91730 Victorville District, 14455 Civic Drive, Victorville, CA 92392 Title of Case (abbreviated) APPLICATION FOR JUDGMENT FOR RESTITUTION OF PREMISES ONLY PURSUANT TO C.C.P. 1169 CASE NUMBER: I am the plaintiff/attorney in the above-entitled action. Defendant(s) was/were served with a summons and complaint on and has/have not appeared and/or answered the complaint. Proof of service of the three-day/thirty day notice to pay or quit and Proof of Service of Summons and Complaint have been filed with the clerk. Pursuant to C.C.P. 1169, Request to Enter Default having been filed, I, the undersigned, request that the default and default judgment be entered for restitution of the premises located at _____________________, California, and that a Writ of Execution issue for possession of premises only. The defendant(s) is/are in possession of the premises. I certify, under penalty of perjury, that the foregoing is true and correct. Executed on at , California. Signature Print Name APPLICATION FOR JUDGMENT FOR RESTITUTION OF PREMISES ONLY, PURSUANT TO C.C.P. 1169 13-16418-360 SB-349 (Civil) Rev 08-2013 American LegalNet, Inc. www.FormsWorkFlow.com