Riverside local form RI-SC002

Source: https://www.riverside.courts.ca.gov/system/files/ri-sc002.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE

BLYTHE 265 N. Broadway, Blythe, CA 92225 MORENO VALLEY 13800 Heacock St., Ste. D201, Moreno Valley, CA 92553 CORONA 505 S. Buena Vista Rm. 201, Corona, CA 92882 PALM SPRINGS 3255 E. Tahquitz Canyon Way, Palm Springs, CA 92262 MENIFEE 27401 Menifee Center Dr., Menifee, CA 92584

RI-SC002

PARTY (Name and Address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional);

ATTORNEY FOR (Name);

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT: CASE NUMBER:

SMALL CLAIMS DECLARATION (CCP§ 170.6)

I, declare that I am the

Plaintiff/Petitioner Defendant/Respondent Other:
in this action.

The Judge/Commissioner: of the above entitled court before whom the trial of the aforesaid action is assigned, is prejudiced against the interest of said party cannot, or he/she believes that he/she cannot, have a fair and impartial trial or hearing before said Judge/Commissioner.

I, the undersigned declare under penalty of perjury under the laws of the State of California that I am the judgment debtor and the above statements are true and correct.

Date: (SIGNATURE OF DECLARANT)

The declaration having been timely filed; the clerk may proceed to send case for re-assignment.

The declaration not having been timely filed; the case will not be reassigned.

Date: (JUDGE OF THE SUPERIOR COURT)

Approved for Optional Riverside Superior Court Use SMALL CLAIMS DECLARATION (CCP§ 170.6) Code of Civilriverside.courts.ca.govProcedure §170.6 RI-SC002 [Rev. 07/29/13] (Reformatted 08/01/26)