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Jury Fee Deposit Form

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY

TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, ALAMEDA COUNTY

STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME

PLAINTIFF: DEFENDANT: OTHER:

CASE NUMBER:

DECLARATION AND ORDER FOR PAYMENT OF MONEY (Jury Fee Deposit)

1. I (name): declare that jury fees have been posted in strict compliance with Code of Civil Procedure § 631 in the above-captioned action. There has been no previous order to refund or forfeit the deposit and it is eligible for refund as provided under Code of Civil Procedure § 631.3. Receipt No.: ______________________________ Dated: ______________________.

2. IT IS REQUESTED that the sum of $ ________________________ as deposited above be paid to: Claimant: ____________________________________________________________________________________ Address: _____________________________________________________________________________________ ______________________________________________________________________________________

3. I declare under penalty of perjury under the law of the State of California that the forgoing is true and correct.

Executed at: _______________________________________, California, on ____________________________.

__________________________________________________

CLAIMANT / DECLARANT

FOR COURT USE ONLY Jury Fee Deposit ­ Eligible for Refund. Request is over 20 days from date case settled/dismissed/continued ­ Not Eligible for Refund. Jury Fee Deposit previously refunded on _______________________ ­ Not Eligible for Refund. Other: ___________________________________________________________________________

Verified by: _______________________________________________________ Date: _________________________

Page 1 of 2

Superior Court of California, County of Alameda

DECLARATION AND ORDER FOR PAYMENT OF MONEY (Jury Fee Deposit)

Jury Fee Deposit Form

PLANTIFF:

CASE NUMBER:

DEFENDANT:

ORDER FOR PAYMENT OF MONEY

The request for refund of the jury fee deposit is

GRANTED.

DENIED.

Date:

_________________________________________________________

JUDGE OF THE SUPERIOR COURT

Page 2 of 2

Superior Court of California, County of Alameda

DECLARATION AND ORDER FOR PAYMENT OF MONEY (Jury Fee Deposit)

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