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 SAN LUIS OBISPO COUNTY San Luis Obispo Branch, 1035 Palm Street, Rm 385, San Luis Obispo, CA 93408 Grover Beach Branch, 214 South 16th Street, Grover Beach, CA 93433 Paso Robles Branch, 901 Park Street, Paso Robles, CA 93446 Plaintiff/Petitioner: Defendant/Respondent: DECLARATION RE: RENT AND DAMAGES (3-DAY NOTICE) Line 1 Line 2 Line 3 Line 4 Line 5 Line 6 Line 7 Line 8 Line 9 CASE NUMBER: Enter amount of monthly rent........................................................................................................................................................ Enter amount of daily rent. (Amount in Line 1 divided by 30. See chart on reverse).......................... Enter the date of the first day rent was due and unpaid. (Date format is MMDDYY) Enter the date the 3-day notice was served. (Date format is MMDDYY) ....................... ................................................... Enter the expiration date of the 3-day notice (Note: If the notice period expires on a weekend/holiday, it is extended until the next day.) (Date format is MMDDYY) ................................. Enter the number of days for which rent was due. (Subtract the date in Line 3 from the date in Line 5) Total rent due (Line 6 x Line 2) .............................................................................................. .............................................................................................................................................. ................. Fair daily rental value (Use the figure in Line 2 unless the value is greater or less.) If attorney fees are authorized in the agreement, please indicate page or paragraph number Line 10 Attorney fees requested pursuant to rental agreement............................................................................................ Line 11 Attorney fees requested pursuant to the rules of court ........................................................................................ DECLARATION I declare under penalty of perjury that the foregoing is true and correct and if sworn as a witness I could testify competently thereto and that this declaration was executed at (fill in name of city) , County of (fill in name of county) , on (fill in date you sign) . PRINT NAME SIGNATURE OF DECLARANT FOR COURT USE ONLY Line 12 Enter judgment date (Format is MMDDYY) .............................................................................................................. Line 13 Enter number of days from end of 3-day notice until judgment date (Line 12 minus Line 5)........ Line 14 Total unlawful detainer damages (Line 13 times Line 8).......................................................................................... Line 15 Attorney fees awarded ....................................................................................................................................................................... Line 16 GRAND TOTAL (Line 7 + Line 14 + Line 15)................................................................................................................... CVUD07 Rev. 08/01/2009 Optional DECLARATION RE: RENT AND DAMAGES (3-DAY NOTICE) CCP1161 American LegalNet, Inc. www.FormsWorkFlow.com