Fillable NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT (LA Court)

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NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT (LA Court)

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LACIV 015 (Rev. 12-14)
PEREMPTORY CHALLENGE TO JUDICIAL OFFICER
(Code Civ. Proc., § 170.6)
Code Civ. Proc., § 170.6
LASC Approved 04-04
For Optional Use
NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY:
ATTORNEY FOR (Name):
STATE BAR NUMBER:
Reserved for Clerk’s File Stamp
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
COURTHOUSE ADDRESS:
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
PEREMPTORY CHALLENGE TO JUDICIAL OFFICER
(Code Civ. Proc., § 170.6)
CASE NUMBER:
Dept. Number:
Judge Commissioner Referee
I am a party (or attorney for a party) to this action or special proceeding. The judicial officer named
above, before whom the trial of, or a hearing in, this case is pending, or to whom it has been
assigned, is prejudiced against the party (or his or her attorney) or the interest of the party (or his or
her attorney), so that declarant cannot, or believes that he or she cannot, have a fair and impartial
trial or hearing before the judicial officer.
DECLARATION
I declare under penalty of perjury, under the laws of the State of California, that the
information entered on this form is true and correct.
Filed on behalf of:
Plaintiff/Petitioner
Cross Complainant
Name of Party
Defendant/Respondent
Cross Defendant
Other:
Dated:
Signature of Declarant
Printed Name
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NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT (LA Court)

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Completed 26 January 2021

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