SUPERIOR COURT OF CALIFORNIA
COUNTY OF SANTA CLARA
Complete information below: Date:
Name:
Address:
City: State: Zip:
Day Phone: Fax#:
Case number or year case number started:
Case Name:
Q
ty Unit Price Total
Preparing copies of any record (per page) ........................................... $ .50
Certifying a dissolution of marriage in addition to the copying fee ....... $25.00
A
search fee is required if you are unable to provide all of the
following information: ............................................................................ $15.00
• Case number
• Case name
• Title of document(s)
• Date document(s) filed ........................................................... $15.00
Exemplification of a record (Government Cod 26839) ........................ $20.00
Fax requests (first page/additional pages) .......................................... $3.00/1.00
TOTAL
Document(s) requested:
Date of Transaction: HP Confirmation#:
**
*THERE IS A TRANSFER FEE OF $5.95 TO PROCESS PAYMENT BY CREDIT CARD**
(Please advise customer of this charge)
CREDIT CARD: VISA MASTERCARD AMERICAN EXPRESS DISCOVER
Cardholder’s Name: Card Number:
Expiration Date: Verification Number: Zip Code: Denied
CW-9023 REV 6/24/15
