El Dorado — Refund Request

Source: https://www.eldorado.courts.ca.gov/system/files/forms-and-filings/m-71-refund-request.pdf

Attorney or Party Without Attorney (Name, State Bar Number, and Address):

Phone Number: Fax Number: Email Address: SUPERIOR COURT OF CALIFORNIA COUNTY OF EL DORADO ☐ 2850 Fairlane Court, Suite 120, Placerville, CA 95667 ☐ 495 Main Street, Placerville, CA 95667 ☐ 1354 Johnson Blvd., South Lake Tahoe, CA 96150 ☐ 295 Fair Lane, Placerville, CA 95667 ☐ 2927 Meder Road, Cameron Park, CA 95682 TITLE OF CASE: CASE NUMBER:

REFUND REQUEST

Note: Refunds for eFiling fees will be sent directly to the Electronic Filing Service Provider (EFSP)

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

Payment Date: Amount Paid:

Receipt/Transaction ID:

Payor (Printed Name):

Mailing Address, City, State, Zip:

Phone Number:

Date: Signature: SIGN

Mandatory Use Refund Request Page 1 of 1 Local Form M-71 Effective 04/01/2025