San Bernardino — 13-16503-360

Source: https://sanbernardino.courts.ca.gov/system/files/forms-filing/13-16503-360certificateofassignmentfillable.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO

Case No.:

vs. CERTIFICATE OF ASSIGNMENT

A civil action or proceeding presented for filing must be accompanied by this Certificate. If the ground is the residence of a party, name and residence shall be stated.

The undersigned declares that the above-entitled matter is filed for proceedings in the District of the Superior Court under Rule131 and General Order of this court for the checked reason: General Collection Nature of Action Ground 1. Adoption Petitioner resides within the district . 2. Conservator Petitioner or conservatee resides within the district. 3. Contract Performance in the district is expressly provided for. 4. Equity The cause of action arose within the district. 5. Eminent Domain The property is located within the district. 6. Family Law Plaintiff, defendant, petitioner or respondent resides within the district. 7. Guardianship Petitioner or ward resides within the district or has property within the district. 8. Harassment Plaintiff, defendant, petitioner or respondent resides within the district. 9. Mandate The defendant functions wholly within the district. 10. Name Change The petitioner resides within the district. 11. Personal Injury The injury occurred within the district. 12. Personal Property The property is located within the district. 13. Probate Decedent resided or resides within or had property within the district. 14. Prohibition The defendant functions wholly within the district. 15. Review The defendant functions wholly within the district. 16. Title to Real Property The property is located within the district. 17. Transferred Action The lower court is located within the district. 18. Unlawful Detainer The property is located within the district. 19. Domestic Violence The petitioner, defendant, plaintiff or respondent resides within the district. 20. Other 21. THIS FILING WOULD NORMALLY FALL WITHIN JURISDICTION OF SUPERIOR COURT

The address of the accident, performance, party, detention, place of business, or other factor which qualifies this case for filing in the above-designed district is:

NAME – INDICATE TITLE OR OTHER QUALIFYING FACTOR ADDRESS

CITY STATE ZIP CODE

I declare, under penalty of perjury, that the foregoing is true and correct and that this declaration was executed on at , California.

SIGN

Signature of Attorney/Party

Form # 13-16503-360 CERTIFICATE OF ASSIGNMENT Rev. June 2019 Mandatory Use