San Manuel Tribal Court
San Manuel Indian Reservation
3214 Victoria Avenue
Highland, CA 92346
Phone: (909) 907-6920
REQUEST FOR HEARING
Form RFH 01 • 5/19
Page 1 of 2
I, __________________________________________________, request a hearing in the above referenced case
because of the following reasons:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
The undersigned swears or afrms that the statements set forth above are true and correct, subject to penalties
of making a false afdavit or declaration.
Date: ________________________ _____________________________________________________
Requesting Party’s Signature
Subscribed and sworn before me this _______ day of _________________________________, 20_____.
My commission expires: ____________________________ ________________________________________
Notary Public/Court Clerk
Petitioner’s Name and Address:
_____________________________
Case Number
Respondent’s Name and Address:
*If you need more space, please check this box to indicate
an additional document is attached.