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San Manuel Tribal Court
San Manuel Indian Reservation
3214 Victoria Avenue
Highland, CA 92346
Phone: (909) 907-6920
REQUEST TO DISMISS
Rev. 10/18 Page 1 of 1
I, __________________________________________________, request to dismiss the above referenced case because
of the following reasons:
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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:
Request to Dismiss
_____________________________
Case Number
Respondent’s Name and Address: