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MC-040 ATTORNEY OR PARTY WITHOUT ATTORNEY Name State Bar number and address TELEPHONE NO. FOR COURT USE ONLY To keep other people from seeing what you entered on your form please press the Clear This Form button at the end of the form when finished. FAX NO. All notices and documents regarding the action should be sent to the above address. Date TYPE OR PRINT NAME Form Approved for Optional Use Judicial Council of California MC-040 Rev. January 1 .

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