Madera — Request for Refund Form (MAD-GEN-002)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-gen-002-request-refund-form-new-09-25-2025.pdf

MAD-GEN-002 NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER FOR COURT USE ONLY

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MADERA

COURTHOUSE ADDRESS: 200 South G Street Madera, CA 93637 PLAINTIFF:

DEFENDANT:

CASE NUMBER:

REQUEST FOR REFUND

Please submit any supporting documentation regarding deposit of fees with this form.

I am requesting a refund in the amount of $ _________________ for the following reasons:

---

---

---

Date of payment/deposit: _________________ Amount Paid: $__________ Receipt #: ____________

Depositor: __________________________________________________ Printed Name

Address: _______________________________________________________________________________________________________________ Number Street City State Zip

Signature: ________________________________________________SIGN Date: __________________

TO BE COMPLETED BY THE COURT:

Please note all refunds require judicial approval. Approved Denied Additional Order(s): __________________________________________________________________

---

By: Dated: JUDGE OF THE SUPERIOR COURT

Form Adopted for Optional Use Page 1 of 1 Madera Superior Court Local FormMAD-GEN-002 [NEW 09/25/2025] REQUEST FOR REFUND