For Court Use Only Attorney or Party without Attorney ( Name, Address and Telephone number) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO Barstow District: 235 E Mt View Ave, Barstow, CA 92311 Big Bear District: 477 Summit Blvd, Big Bear Lake, CA 92315 (Mailing address use Victorville District) Chino District: 13260 Central Ave, Chino, CA 91710 Fontana District: 17780 Arrow Blvd, CA 92335 Joshua Tree District: 6527 White Feather Road, Joshua Tree, CA 92252 Needles District: 1111 Bailey Ave, Needles, CA 92363 Rancho Cucamonga District: 8303 N Haven Ave, Rancho Cucamonga, CA 91730 San Bernardino Civil Division: 303 W. Third Street, S.B., CA 92415 Victorville District: 14455 Civic Drive Ste 100, Victorville, CA 92392 Title of Case (abbreviated) APPLICATION FOR JUDGMENT FOR RESTITUTION OF PREMISES ONLY, PURUSANT 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. 1196, 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 3-30-2011 American LegalNet, Inc. www.FormsWorkFlow.com