Choose a location ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF: DEFENDANT: CASE NUMBER: DECLARATION OF PREJUDICE CCP 170.6 (PEREMPTORY CHALLENGE) ________________________________________________________________________________ declares (NAME OF DECLARANT) that he/ she is _____________________________________________ a party to the within action hereinafter (INSERT "ATTORNEY FOR" OR LEAVE BLANK) called "case" therein as follows: ________________________________________________________________________________________ (NAME OR NAMES OF PARTIES) that _______________________________________________, the Judge, Court Commissioner or Referee to (NAME OF JUDGE/COMMISSIONER/REFEREE BEING DISQUALIFIED) whom the case has been assigned is prejudiced against the ____________________________ or the interest (PLAINTIFF OR DEFENDANT) of the _____________________________ so that Declarant cannot or believes that he/she cannot have a fair (PLAINTIFF OR DEFENDANT) and impartial trial or hearing before such Judge, Court Commissioner or Referee. I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Dated: _________________________________ ________________________________________ (SIGNATURE OF DECLARANT) SC-1002 [Rev. July 1 ,1999] DECLARATION OF PREJUDICE CCP 170.6 (PEREMPTORY CHALLENGE) CCP 170.6 American LegalNet, Inc. www.FormsWorkFlow.com