SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE
BANNING 135 N. Alessandro Rd., Banning, CA 92220
MORENO VALLEY 13800 Heacock St., Ste. D201, Moreno Valley, CA 92553
BLYTHE 265 N. Broadway, Blythe, CA 92225
MURRIETA 3077-D Auld Rd., Murrieta, CA 92563
CORONA 505 S. Buena Vista, #201, Corona, CA 92882
PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262
HEMET 880 N. State St., Hemet, CA 92543
RIVERSIDE 4050 Main St., Riverside, CA 92501
RI-ADR12
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address)
FOR COURT USE ONLY
TELEPHONE NO:
FAX NO. (Optional):
E-MAIL ADDRESS
(Optional):
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT:
CASE NUMBER:
Proof of Service of Statement of Agreement/Nonagreement
By Mail, Fax, or Electronic Service
I, the undersigned, say: I am over the age of eighteen years and not a party to the within action or
proceeding. My residence or business address is:
On the
Day of
, I served a copy of the paper to which this proof of
service by mail is attached, STATEMENT OF AGREEMENT/NONAGREEMENT as follows:
By United States mail. I deposited said copy enclosed in a sealed envelope with postage hereon
fully prepaid, in the United States Postal Service mail box at the City of:
,
California, addressed as follows:
By fax transmission. Based on an agreement of the parties to accept service by fax transmission, I
faxed the Statement of Agreement/Nonagreement to the persons listed at the fax numbers below.
No error was reported by the fax machine that I used. A copy of the record of the fax transmission,
which I printed out, is attached.
Names
Fax Numbers
The fax number from which I served the documents is (complete if service was by fax):
Page 1 of 2
Approved for Optional Use
Riverside Superior Court
RI-ADR12 [Rev. ]
(Reformatted 01/07/19)
Proof of Service of Statement of
Agreement/Nonagreement
By Mail, Fax, or Electronic Service
riverside.courts.ca.gov/localfrms/localfrms.shtml
PLAINTIFF:
DEFENDANT:
CASE NUMBER:
By electronic service. Based on an agreement of the parties to accept service by electronic
transmission, I caused the documents to be sent to the persons at the electronic notification
addresses listed below:
Names
E-mail Addresses
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF DECLARANT)
Page 2 of 2
Approved for Optional Use
Riverside Superior Court
RI-ADR12 [Rev. 07/29/13]
(Reformatted 01/07/19)
Proof of Service of Statement of
Agreement/Nonagreement
by Mail, Fax, or Electronic Service
riverside.courts.ca.gov/localfrms/localfrms.shtml
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