ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 CENTRAL DIVISION, HALL OF JUSTICE, 330 W. BROADWAY, SAN DIEGO, CA 92101 CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 CENTRAL DIVISION, KEARNY MESA , 8950 CLAIREMONT MESA BLVD., SAN DIEGO, CA 92123 CENTRAL DIVISION, JUVENILE COURT, 2851 MEADOW LARK DR., SAN DIEGO, CA 92123 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PLAINTIFF(S)/PETITIONER(S) DEFENDANT(S)/RESPONDENT(S) CASE NUMBER REQUEST FOR PAYMENT OF TRUST FUNDS / REFUND DECLARATION I, for: payee noted below by reason of: I declare under penalty of perjury, under the laws of the State of California, that the forgoing is true and correct. Date: Signature of Requester , Court Reporter Party Attorney Other: is presently due and owing to the declare that the sum of $ Payee Name: (Last) (First) (City) (MI) (State) (Tel. No.) (Zip Code) Address: (Street) If court order provided for interest, provide payee's tax I.D.# and mailing address for tax reporting: (Tax ID #) (Street) (City) (State) (Zip Code) FOR COURT USE ONLY I certify that the sum of $ attached order FMS other: , dated Clerk of the Superior Court Date: Approved Date: SDSC CIV-180 (Rev. 12/13) is presently due and payable to the payee noted above by reason of: CCMS V3 Receipt Number . by Denied: , Deputy Signature of Supervisor or Manager REQUEST FOR PAYMENT OF TRUST FUNDS / REFUND Cal. Rules of Ct., rule 8.130, Gov. Code § 69953, & Code Civ. Proc. § 631.3 American LegalNet, Inc. www.FormsWorkFlow.com