Fillable SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO (California)

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO (California)

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Case #:
Case Name:
Card #:
16-digit credit card number
Expiration Date: Security Code*:
*The security code is a 3-
digit number found on the reverse of the credit
card near the signature panel and following the account number
Amount to be Charged: $ Visa MasterCard American Express
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Billing Address:
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Cardholder Name:
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Daytime Phone #: ( )
Date:
Cardholder Signature:
For Office Use Only
Clerk’s name if payment processed telephonically
SDSC ADM-253 (Rev. 10/18) CREDIT CARD PAYMENT
(CONFIDENTIAL)
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
CREDIT CARD PAYMENT
(CONFIDENTIAL)
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO (California)

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Completed 29 December 2021

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