VN015 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 800 SOUTH VICTORIA AVE. VENTURA, CA 93009 3855 ­ F ALAMO ST. SIMI VALLEY, CA 93063-2110 4353 VINEYARD AVE., OXNARD, CA 93036 PLAINTIFF/PETITIONER DEFENDANT/RESPONDENT CERTIFICATE RE: DISQUALIFICATION OF JUDGE (CCP 170.6) CASE NUMBER: I am the attorney for the _____________________________________________________________________________ in the within action. ________________________________________________________________ , the Judge before whom the trial of said action is pending is prejudiced against the interest of the ___________________________________________________ so that I believe a fair and impartial trial of said action cannot be had before said Judge. I certify under penalty of perjury that the foregoing is true and correct. Executed on ______________________________________ at ____________________________________ , California. ______________________________________________ Signature of Certifying Party Optional Form VN015 (Rev. 07/03) CERTIFICATE RE: DISQUALIFICATION OF JUDGE (CCP 170.6) American LegalNet, Inc. www.FormsWorkFlow.com