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E-FILED
2/20/2018 12:01 PM
Clerk of Court Superior Court of CA, County of Santa Clara 16CV294256 Reviewed By: R. Aragon Envelope:1234438
2/20/2018 12:01 PM
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2/20/2018 12:01 PM
R. Aragon 2/20/2018 12:01 PM
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ClV-110 CASE NUMBER:
1SCV294256
PLAINTIFF/PETlTIONER: Sima Moshiri DEFENDANT/RESPONDENT: Veronica Espinoza Sanchez, et a1.
COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS recover $10,000 or a party whose court fees and costs were initially waived has recovered or will or other settlement, mediation award, arbitration compromise, more in value by way of settlement, the case until means, the court has a statutory lien on (hat recovery. The court may refuse to dismiss the lien is satisfied. (Gov. Code, § 68637.) If Declaration Concerning Waived Court Fees 1.
The 2.
The person named court waived court fees [j E E E3 3r b, c‘ 3.
I All in item and costs 1 is in this action for (name):
(check one below):
not recovering anything of value by this action. recovering less than $10,000 recovering $10,000 or court fees and more coun costs that in in value by value by this action this action, (Ifilem were waived in this 20 action have is checked, item 3 must be completed.) been paid to the court (check one):
information above declare under penalty of perjury under the laws of the State of California tha( the is true and D E YES N0 correct.
Date:
(TYPE
0R PRINV NAME 0F
E CIV-HOIRev.January1.20131 b (SIGNATURE) ATTORNEV [:J PARTY MAKING DECLARATION) REQUEST FOR DISMISSAL Page 2 of Z
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