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YOUR NAME
STREET ADDRESS
CITY, STATE, ZIP
PHONE NUMBER WITH AREA CODE

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YOUR NAME, IN PRO PER

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SUPERIOR COURT OF THE STATE OF CALIFORNIA

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FOR THE COUNTY OF SACRAMENTO

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NAME OF PLAINTIFF,

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Plaintiff,
vs.
NAME OF DEFENDANT,
Defendant

) Case No.: INSERT CASE NUMBER

)
)
) DECLARATION IN SUPPORT OF
) MOTION FOR PEREMPTORY CHALLENGE
)
)
)
)
)

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I, YOUR NAME declare that:

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1. I am the INSERT EITHER PLAINTIFF OR DEFENDANT in the aboveentitled matter.

2. The Honorable INSERT THE NAME OF THE JUDGE YOU WISH TO REMOVE,

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Judge to whom the INSERT TRIAL OR HEARING of the above-entitled

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DECLARATION IN SUPPORT OF PEREMPTORY CHALLENGE

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matter is pending in INSERT DEPARTMENT NUMBER is prejudiced

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against the INSERT EITHER PLAINTIFF OR DEFENDANT.

3. Declarant believes that the INSERT EITHER PLAINTIFF OR

DEFENDANT cannot have a fair and impartial trial or hearing

before this Judge.

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I declare under penalty of perjury under the laws of the State of

California that the foregoing is true and correct.

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Dated: INSERT DATE

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YOUR NAME

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In Pro Per

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- 2 -

DECLARATION IN SUPPORT OF PEREMPTORY CHALLENGE