SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE
BLYTHE 265 N. Broadway, Blythe, CA 92225
INDIO 46-200 Oasis St., Indio, CA 92201
HEMET 880 N. State St., Hemet, CA 92543
RIVERSIDE 4175 Main St., Riverside, CA 92501
RI-FL037
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address)
FOR COURT USE ONLY
TELEPHONE NO.:
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
PETITIONER:
RESPONDENT:
CASE NUMBER:
Hearing Date: Time: Department:
STIPULATION AND ORDER ON REQUEST FOR ORDER
THE PARTIES HEREBY STIPULATE AND AGREE AS FOLLOWS:
(ATTORNEY FOR PETITIONER OR PETITIONER) (ATTORNEY FOR RESPONDENT OR RESPONDENT)
SIGNATURE OF PARTIES
We have read the entire stipulation and agreement. We understand fully and request the Court to make our stipulation
and agreement the Court’s order. We understand that willful failure to comply with the provisions of this order will be a
contempt of Court and may be punishment by fine and imprisonment. We waive all further notice of this order.
(HUSBAND) (WIFE)
IT IS SO ORDERED THIS day of , 20 .
Judge of the Superior Court
Page 1 of 1
Adopted for Optional Use
Riverside Superior Court
RI-FL037 [Rev. 04/04/13]
STIPULATION AND ORDER ON REQUEST FOR ORDER
riverside.courts.ca.gov/localfrms/localfrms.shtml
