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Any Attorney or Party Any Street Any Town, CA 99999 555-555-5555 Any attorney or party

Superior Court of the State of California For the County of ____________

Any Plaintiff, Plaintiff, vs. Any Defendant, Does 1-50, inclusive, Defendants.

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Case No. PEREMPTORY CHALLENGE

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1I, _______, declare as follows: 1. I am over the age of 18 years. I am a party (or the attorney for a party) to the above-

entitled action. That the judge, court commissioner, or court referee before whom the trial of (or a
- 1 PEREMPTORY CHALLENGE-SECTION 170.6 OF THE CODE OF CIVIL PROCEDURE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 - 2 PEREMPTORY CHALLENGE-SECTION 170.6 OF THE CODE OF CIVIL PROCEDURE

hearing) in the above-entitled action or proceeding (or to whom it is assigned) is prejudiced against the party (or his or her attorney) or the interest of the party (or his or her attorney) so that I cannot have a fair and impartial trial or hearing before the judge, court commissioner or referee.

Remember that you must file this motion, and then serve the motion on all parties to a civil action within the time limits specified in Code of Civil Procedure Section 170.6. Visit the following website: http://www.leginfo.ca.gov/calaw.html to search for and view the full text of Section 170.6
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on __________________,2013 at _____, California. ___________________________________________________ PERSON SIGNING PEREMPTORY CHALLENGE