Saracino v. Tesla, Inc. Document 1

Filed January 28, 2019

Back to Saracino v. Tesla, Inc., Superior Court of California, County of Contra Costa Case No. MSMSC19-0097

PLAINTIFF'S CLAIM AND ORDER TO DEFENDANT FILED (CLAIM GREATER THAN $1,500.00 UP TO $5,000.00)

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Page 1 Plaintiff's Claim and ORDER
ae to Go to Small Claims Court
Notice to the person being sued:
You are the defendant if your name is listed in @) on page 2 of this form.
The person suing you is the plaintiff, listed in (1) on page 2.
You and the plaintiff must go to court on the trial date listed below. If you
do not go to court, you may lose the case.
If you lose, the court can order that your wages, money, or property be
taken to pay this claim.
Bring witnesses, receipts, and any evidence you need to prove your case.
Read this form and all pages attached to understand the claim against you
and to protect your rights.
Aviso al Demandado:
Usted es el Demandado si su nombre figura en @) de la pagina 2 de este
formulario. La persona que lo demanda es el Demandante, 1a que figura en
C1) de la pagina 2.
Usted y el Demandante tienen que presentarse en la corte en Ja fecha del
juicio indicada a continuacién. Si no se presenta, puede perder el caso.
Si pierde el caso la corte podria ordenar que le quiten de su sueldo, dinero u
otros bienes para pagar este reclamo.
Lleve testigos, recibos y cualquier otra prueba que necesite para probar su
caso,
yok y yO
I i NS
: Leo it rote

8
3
ig
pa et mel gt na
Clerk ifrestiet ee when folm is filed.
£ a he
i
* if it
Aootee: bse: thd
209 JAN 28 AM 11:59
KATE SIEKER
CLERK OF THE SNPERIOR COURT
COUNTY oF 04 BA SOSA CA
Ne
3
BY:

Fill in court name and street address:

Superior Court of California, County of
Superior Court of Contra Costa County
725 Court Street
Martinez, CA 94553

Court fills in case number when form is filed.

WStis . 0 0 9 7
Case Name:

Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos.
O)us(stmromClemcomOcolt lat
The people in (4) and (2) must go to court: (Clerk fills out section below.)

. > Date Time Department Name and address of court, if different from above
Trial ;
08-28-19 1:30 pa 27 Me (GR
Date 3
2 “7

3.

, Deputy

bs
Date: JAN 28 2019 Clerk, by L. DIAZ

Instructions for the person suing:
You are the plaintiff. The person you are suing is the defendant.
Before you fill out this form, read form SC-100-INFO, Information for the Plaintiff; to know your rights. Get
SC-100-INFO at any courthouse or county law library, or go to www.courts.ca. gov/smallelaims/forms.
Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Make one copy for each party named in
this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk’s office and pay
the filing fee. The clerk will write the date of your trial in the box above.
You must have someone at least 18—not you or anyone else listed in this case—give each defendant a court-stamped
copy of all five pages.of this form and any pages this form tells you to attach. There are special rules for “serving,” or
delivering, this form to public entities, associations, and some businesses. See forms SC-104, SC-104B, and 5C-104C.
Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case.

Judicial Council of California, www.courts.ca.gov
Revised January 1, 2017, Mandatory Forn
Code of Civil Procedure, §§ 116.110 ef seq.,
116.220(0), 116.340(g)
(Small Claims)
Plaintiffs Claim and ORDER
to Go to Small Claims Court
$C-100, Page 1 of 5
—>

Page 2 Plaintiff (list names): Number:

(1) The plaintiff (the person, business, or public entity that is suing) is:

Name: Tapa Cavac No Phone: 26, DIS. 2000
Street address: 3)\34 Meadow Brook DYNe Convoy Ca 445)4
Street City State Zip
Mailing address (if different):
Street City State = Zip
If more than one plaintiff, list next plaintiff here:
Name: Phone:
Street address:
Street City State Zip
Mailing address (if different):

Street City State Zip
["] Check here if more than two plaintiffs and attach form SC-I00A.
[] Check here if either plaintiff listed above is doing business under a fictitious name. if so, attach form SC-103.
(1 Check here if any plaintiff is a “licensee” or “deferred deposit originator” (payday lender) under Financial
Code sections 23000 et seq.
(2) The defendant(the person, business, or public entity being sued) is:

Name: TOG, INC. Phone:
Street address: 455 00 Fryeott_B)vd rremoriy Chk 44g ag
Street City State Zip
Mailing address (if different):

Street City State Zip
If the defendant is a corporation, limited liability company, or public entity, list the person
or agent authorized for service of process here: .

Name: € T_COryoraNon sysiem: Job title, if known:
Address: DG War Ceventh Qirecy Sie 4 ho Loe 0 ngeles of 400 |F
Jo Am And @ q dir ag City State Zip
[1] Check here if your case is against more than one defendant, and attach form SC-100A.
[] Check here if any defendant is on active military duty, and write his or her name here:
(3) The plaintiff claims the defendant owes $ 3, 70 + . (Explain below):
a. Why does the defendant owe the plaintiff money? . _
Eefund of fiooy Verervation par the _Covivact plus lOc} interes} lost fme q
eouvt Tega) fees.
When did this happen? (Date): Wy 24, WG ~ NOW
b. Ifno specific date, give the time period: Date started: Through:
c. How did you calculate the money owed to you? Fe not include court costs or fees for service.) _ oo.
Hoc Wwservenan; #143 40 initrert (iodo «2.05°/. x F onthe); +2,s00 in lost time
(io hou @ ity bilf rate of F 27b))_blut cover ¥ Serving es (Hp)
L]} Check here if you need more space. Attach one sheet of paper or form MC-031 and write “SC-100, Item 3” at
the top.

Revised January 1, 2047 Plaintiff's Claim and ORDER to Go to Small Claims Court SC-100, Page 2 of 5
(Small Claims) >

Page 3 Plamtiff (list names): Case Number:

(4) You must ask the defendant (in‘person, in writing, or by phone) to pay you before you
sue. If your claim is for possession of property, you must ask the defendant to give you
the property. Have you done this?
(1 No If no, explain why not:
Yes r ot: ae 4 4 . ‘ . ro
i Gt 4 tarhhed donvnd fle on Dec it, Dos 7 Feslas itgal det m fremort {
Tele wacered aden CT Loiperaheh eysten jh LA: *
Why are you filing your claim at this courthouse?
This courthouse covers the area (check the one that applies):
a. LC] (1) Where the defendant lives or does business. (4) Where a contract (written or spoken) was made,
(2) Where the plaintiff’s property was damaged. signed, performed, or broken by the defendant or
(3) Where the plaintiff was injured. where the defendant lived or did business when the
defendant made the contract.
b. [1] Where the buyer or lessee signed the contract, lives now, or lived when the contract was made, if this claim,
is about an offer or contract for personal; family, or household goods, services, or loans. (Code Civ. Proc.,
$ 395(b),) .
c. [1 Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about a
retail installment contract (like a credit card). (Civ Code, § 1812.10.)
d. [) Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle is
permanently garaged, if this claim is about a vehicle finance sale. (Civ Code, § 2984.4.)
e. ‘) Other (specify): | wad? the Hivos reservation oling ib Fachete

List the zip code of the place checked in © above (ifyou know): Gd %
Is your claim about an attorney-client fee dispute? [] Yes — °
If yes, and if you have had arbitration, fill out form SC-101, attach it to this form, and check here: []
(8) Are you suing a public entity? [] Yes EYNo
form is true correct.
Revised January 1, 2017
If yes, you must file a written claim with the entity first. {_] A claim was filed on (date):
If the public entity denies your claim or does not answer within the time allowed by law, you can file this form.
Have you filed more than 12 other smaii claims within the iast 12 months in California?
[] Yes No Ifyes, the filing fee for this case will be higher.
is your claim for more than $2,5007 ph ves C No
If yes, I have not filed, and understand that I canrot file, more than two small claims cases for more than $2,500 in
California during this calendar year.
l understand that by filing a claim in small claims court, | have no right to appeal this
claim.
Date: 4) iG Tanya x dG Cito
Plaintiff types or prints name here

Date:

Second plaintiff types or prints name here Second plaintiff signs here
Requests for Accommodations
i Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter
aservices are available if you ask at least five days before the trial. Contact the clerk’s office for form
2 MC-410, Request for Accommodations by Persons With Disabilities and Response. (Civ. Code, § 54.8.)

Plaintiff's Claim and ORDER to Go to Small Claims Court $C-100, Page 3 of 5
(Small Claims) >

Page 4 Tome Tilt) Information for the defendant (the person being sued)

"Smail claims court" is a special court where claims for
$10,000 or less are decided. Individuals, including "natural
persons” and sole proprietors, may claim up to $10,000.
Corporations, partnerships, public entities, and other businesses
are limited to claims of $5,000. (See below for exceptions.*) The
process is quick and cheap. The rules are simple and informal.
You are the defendani—the person being sued. The person who is
suing you Is the plaintiff.
Do I need a lawyer? You may talk to a lawyer before or after
the case. But you may not have a lawyer represent you in court
(unless this is an appeal from a small claims case).
How do | get ready for court? You don’t have to file any
papers before your trial, unless you think this is the wrong court
for your case. But bring to your trial any witnesses, receipts, and
evidence that supports your case. And read “Be Prepared for Your
Trial’ at www.courts.ca.gov/smaliclaims/prepare.
What if | need an accommodation? If you have a
disability or are hearing impaired, fill out form MC-410, Request for
Accommodations. Give the form to your court clerk or the ADA/
Access Coordinator.
What if | don’t speak English well? Ask the court clerk
as soon as possible if your court has a court-provided interpreter
available and how to request one. A court-provided interpreter may
not be available. Alternatively, you may bring an adult who is not a
witness or an attomey to interpret for you or ask the court for a list
of interpreters for hire.
Where can I get the court forms | need? Go to any
courthouse or your county law library, or print forms at www.
courts.ca. gov/smaliclaims/forms.
What happens at the trial? The judge will listen to both
sides. The judge may make a decision at your trial or mail the
decision to you later.
What if | lose the case? if you lose, you may appeal. You’ll
have to pay a fee. (Plaintiffs cannot appeal their own claims.)
» If you were at the trial, file form SC-140, Notice of Appeal. You
must file within 30 days after the clerk hands or mails you the
judge's decision (judgment) on form SC-200 or form SC-130,
Notice of Entry of Judgment.
If you were not at the trial, fill out and file form SC-135, Notice of
Motion to Vacate Judgment and Declaration, to ask the judge to
cancel the judgment (decision). If the judge does not give you a
new trial, you have 10 days to appeal the decision. File form
SC-140.
’ For more information on appeals, see www.courts.ca.gov/
smailclaims/appeals.
Do | have options?
Yes. If you are being sued, you can:
- Settle your case before the trial. If you and the
plaintiff agree on how to settle the case, the plaintiff must file
form CIV-110, Request for Dismissal, with the clerk. Ask the
Smail Claims Advisor for help.
- Prove this is the wrong court. Send a letter to the court
before your trial explaining why you think this is the wrong court.
Ask the court to dismiss the claim. You must serve (give) a copy
of your letter (by mail or in person) to all parties. (Your letter to
the court must say you have done so.)
- Go to the trial and try to win your case. Bring
witnesses, receipts, and any evidence you need to prove your
case. To have the court order a witness to go to the trial, fill out
form SC-107 (Smail Claims Subpoena) and have it served on
the witness.
- Sue the person who is suing you. if you have a claim
against the plaintiff, and the claim is appropriate for srnall claims
court as described on this form, you may file Defendant's Claim
(form SC-120) and bring the claim in this action. If your claim is
for more than allowed in small claims court, you may siill file it in
smail claims court if you give up the amount over the small
claims value amount, or you may file a claim for the full value of
the claim in the appropriate court. If your claim is for more than
allowed in smail claims court and relates to the same contract,
transaction, matter, or event that is the subject of the plaintiff's
claim, you may file your claim in the appropriate court and file a
motion to transfer the plaintiff's 's claim to that court to resolve
both matters together. You can see a description of the amounis
aliowed in the paragraph above titled “Small Claims Court.”
- Agree with the plaintiff's claim and pay the
money. Or, if you can’t pay the money now, go to your trial
and say you want to make payments.
- Let the case "default." If you don’t settle and do not go to
the trial (default), the judge may give the plaintiff wnat he or she
is asking for plus court costs. If this happens, the plaintiff can
legally take your money, wages, and property to pay the
‘judgment.
What if | need more time?
You can change the trial date if:
« You cannot go to court on the scheduled date (you will have to
pay a fee to postpone the trial), or
- You did not get served (receive this order to go to court) at least
days before the trial (or 20 days if you live outside the
county), or
- You need more time to get an interpreter. One postponement is
allowed, and you will not have to pay a fee to delay the trial.
Ask the Small Claims Clerk about the rules and fees for
postponing a trial. Or fill out form SC-150 (or write a letter) and
mail it to the court and to all other people listed on your court
papers before the deadline. Enclose a check for your court fees,
unless a fee waiver was granted.
@
f
L_
Or go to www.courts.ca.gov/smaliclaims/advisor.
Need help?
Your county’s Small Claims Advisor can help for free.
~
_|
* Exceptions: Different limits apply in an action against a defendant who is a guarantor. (Gee Code Civ. Proc., § 116.220(c).)
Revised January 1, 2017
(Smail
Plaintiff's Claim and ORDER to Go to Small Claims Court
SC-100, Page 4 of 5
—_
Claims)

Page 5 Sometime Informacion para el demandado (la persona demandada)

La “Corte de reclamos menores” es una corte especial donde se
deciden casos por $10,000 o menos. Los individuos, o sea las
“personas fisicas” y los propietatios por cuenta propia, pueden
reclamar hasta $10,000. Las corporaciones, asociaciones, entidades
plblicas y otras empresas solo pueden reclamar hasta $5,000. (Vea
abajo para las excepciones.*) El proceso es rapido y barato. Las
regias son sencillas ¢ informales. Usted es el Demandado—la
persona que se est4 demandando. La persona que lo esta
demandando es el Demandanite.
éNecesito un abogado? Puede hablar con un abogado antes o
después del caso. Pero no puede tener a un abogado que Io
represente ante la corte (a menos que se trate de una apelacién de un
caso de reclamos menores).
2Cémo me preparo para ir a la corte? No tiene que presentar
ningunos papeles antes del juicio, a menos que piense que ésta es la
corte equivocada para su caso. Pero lieve al juicio cualquier testigos,
recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su
juicio” en www.courts.ca.gov/reclamosmenores/preparese.
~Qué hago si necesito una adaptaci6n? Si tiene una discapacidad
0 tiene impedimentos de audicién, llene el formulario MC-410,
Request for Accomodations. Entregue el formulario al secretario de la
corte o al Coordinador de Acceso/ADA de su corte.
2 Qué pasa si no hablo bien inglés? Pregintele al secretario de la
corte lo mas pronto posible si en el juzgado habra un intérprete
disponible y cémo solicitarlo. No siempre estan disponibles los
intérpretes de la corte. Otra opcién es llevar a un adulto que pueda
interpretar para usted siempre que esa persona no sea un testigo ni
un abogado. O puede pedir a la corte una lista de intérpretes
particulares disponibles para contratar.
¢Dénde puedo obtener ios formularios de la corte que necesito?
Vaya a cualquier edificio de la corte, la biblioteca legal de su condado,
o imprima los formularios en www.courts.ca.gov/ smaliclaims/forms
(pagina esta en inglés).
¢Qué pasa en el juicio? El juez escuchara a ambas partes. EI juez
puede tomar su decisién durante la audiencia o enviarsela por correo
después.
éQué pasa si pierdo el caso? Si pierde, puede apelar. Tendra que
pagar una cuota. (El Demandante no puede apelar su propio reclamo.)
. Si estuvo presente en el juicio, lene el formulario SC-140, Aviso de
apelacidn (Notice of Appeal). Tiene que presentarlo dentro de 30
dias después de que el secretario le entregue o envie fa decisién
(fallo) del juez en el formulario SC-200 o SC-130, Aviso de
publicacién del fallo (Notice of Entry of Judgment).
. Sino estuvo en el juicio, Ilene y presente el formulario SC-135,
Aviso de peticién para anular el fallo y Declaracién para pedirle at
juez que anule el fallo (decisi6n). Si la corte no le otorga un nuevo
juicio, tiene 10 dias para apelar la decision. Presente el formulatio
SC-140.
Para obtener mas informacién sobre las apelaciones, vea www.
courts.ca.gov/reclamosmenores/apelaciones.
é Tengo otras opciones? Si. Si lo estan demandando, puede:
. Resolver su caso antes de! juicio. Si usted y el Demandante se
ponen de acuerdo en cémo resolver el caso, el Demandante tiene
que preseniar el formulario CiV-110, Solicitud de desestimacién
(Request for Dismissal) ante el secretario de la corte. Pidale al
Asesor de Reciamos Menores que lo ayude.
. Probar que es la corte equivocada. Envie una carta a !a corte
antes del juicio explicando por qué cree que es Ia corte
equivocada, Plidale a la corte que despida el reclamo.Tiene que
entregar (dar) una copia de su carta (por correo o en persona) a
todas las partes. (Su carta a la corte tiene que decir que hizo la
entrega.)
. lraljuicio y tratar de ganar el caso. Lleve testigos, recibos y
cualquier prueba que necesite para probar su caso. Si desea que
la corte emita una orden de comparecencia para que los testigos
vayan al juicio, llene el formutario SC-107, Citatorio de reclamos
menores (Small Claims Subpoena) y entrégueselo legalmente al
testigo.
. Demandar a la persona que lo demandé6. Si tiene un reclamo
contra el Demandante, y el reclamo se puede presentar en fa
corte de reclamos menores, tal como se describe en este
formulario, puede presentar el formulario SC-120, Reclamo def
demandado (Defendant's Claim) y presentario en este mismo
caso. Si su reclamo excede el limite permitido en la corte de
reclamos menores, puede igualmente presentarlo en fa corte de
reclamos menores si esta dispuesto a limitar su reclamo al
maximo permitido, o puede presentar un reclamo por el monto
total en la corte apropiada. Si su reclamo excede el Ifmite
permitido en la corte de reclamos menores y esta relacionado con
el mismo contrato, transaccién, asunto o acontecimiento que el
reclamo del Demandante, puede presentar su reclamo en fa corte
apropiada y presentar una mocién para transferir el reclamo del
Demandante a dicha corte, pata poder resolver los dos reclamos
juntos. Puede ver una descripcién de los montos permitidos en el
parrafo anterior titulado “Corte de reclamos menores’.
. Aeptar el reciamo del Demandante y pagar el dinero. O, si no
puede pagar en ese momento, vaya al juicio y diga que quiere
hacer los pagos.
No ir al juicio y aceptar el fallo por falta de comparecencia. Si
no llega a un acuerdo con el Demandante y no va al juicio (fallo
por falta de comparecencia), el juez le puede otorgar al
Demandante lo que esta reclamando mas Jos costos de Ia corte.
En ese caso, el Demandante legalmente puede tomar su dinero,
su sueldo o sus bienes para cobrar el fallo.
2Qué hago si necesito mas tiempo? Puede cambiar fa fecha del
juicio si:
» No puede ir a la corte en la fecha programada (tendraé que pagar
una cuota para aplazar el juicio), o
¢ No le entregaron los documentos legalmente (no recibié la orden
para ir a la corte) por lo menos 15 dias antes del juicio (6 20 dias
si vive fuera del condado)}, o
* Necesita mas tiempo para conseguir intérprete. (Se permite un
solo aplazamiento sin tener que pagar cuota para aplazar el
uicio).
pregintale al secretario de reclammos menores sobre las reglas y las
cuotas para aplazar un juicio. O Hlene el formulario SC-150 (© escriba
una carta) y envielo antes del plazo a !a corte y a todas las otras
personas que figuran en sus papeles de la corte. Adjunte un cheque
para pagar los costos de la corte, a menos que le hayan dado una
exencion.
éNecesita ayuda? E! Asesor de Reclamos Menores de su
condado le puede ayudar sin cargo.
_|
O visite www.courts.ca.gov/reclamosmenores/asesores.
* Excepciones: Existen diferentes limites an un reclamo contra un garante. (Vea el Codigo de Procedimiento Civil, seccién 116.220 (c).)
Revised January 1, 2017
Reclamo del Demandante y ORDEN
SC-100, Page 5 of 5
Para Ir ala Corte de Reclamos Menores
(Reclamos Menores)

PDF Page 1	PlainSite Cover Page

PDF Page 2	Plaintiff's Claim and ORDER ae to Go to Small Claims Court Notice to the person being sued: You are the defendant if your name is listed in @) on page 2 of this form. The person suing you is the plaintiff, listed in (1) on page 2. You and the plaintiff must go to court on the trial date listed below. If you do not go to court, you may lose the case. If you lose, the court can order that your wages, money, or property be taken to pay this claim. Bring witnesses, receipts, and any evidence you need to prove your case. Read this form and all pages attached to understand the claim against you and to protect your rights. Aviso al Demandado: Usted es el Demandado si su nombre figura en @) de la pagina 2 de este formulario. La persona que lo demanda es el Demandante, 1a que figura en C1) de la pagina 2. Usted y el Demandante tienen que presentarse en la corte en Ja fecha del juicio indicada a continuacién. Si no se presenta, puede perder el caso. Si pierde el caso la corte podria ordenar que le quiten de su sueldo, dinero u otros bienes para pagar este reclamo. Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso, yok y yO I i NS : Leo it rote 8 3 ig pa et mel gt na Clerk ifrestiet ee when folm is filed. £ a he i * if it Aootee: bse: thd 209 JAN 28 AM 11:59 KATE SIEKER CLERK OF THE SNPERIOR COURT COUNTY oF 04 BA SOSA CA Ne 3 BY: Fill in court name and street address: Superior Court of California, County of Superior Court of Contra Costa County 725 Court Street Martinez, CA 94553 Court fills in case number when form is filed. WStis . 0 0 9 7 Case Name: Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos. O)us(stmromClemcomOcolt lat The people in (4) and (2) must go to court: (Clerk fills out section below.) . > Date Time Department Name and address of court, if different from above Trial ; 08-28-19 1:30 pa 27 Me (GR Date 3 2 “7 3. , Deputy bs Date: JAN 28 2019 Clerk, by L. DIAZ Instructions for the person suing: You are the plaintiff. The person you are suing is the defendant. Before you fill out this form, read form SC-100-INFO, Information for the Plaintiff; to know your rights. Get SC-100-INFO at any courthouse or county law library, or go to www.courts.ca. gov/smallelaims/forms. Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Make one copy for each party named in this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk’s office and pay the filing fee. The clerk will write the date of your trial in the box above. You must have someone at least 18—not you or anyone else listed in this case—give each defendant a court-stamped copy of all five pages.of this form and any pages this form tells you to attach. There are special rules for “serving,” or delivering, this form to public entities, associations, and some businesses. See forms SC-104, SC-104B, and 5C-104C. Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. Judicial Council of California, www.courts.ca.gov Revised January 1, 2017, Mandatory Forn Code of Civil Procedure, §§ 116.110 ef seq., 116.220(0), 116.340(g) (Small Claims) Plaintiffs Claim and ORDER to Go to Small Claims Court $C-100, Page 1 of 5 —>

PDF Page 3	Plaintiff (list names): Number: (1) The plaintiff (the person, business, or public entity that is suing) is: Name: Tapa Cavac No Phone: 26, DIS. 2000 Street address: 3)\34 Meadow Brook DYNe Convoy Ca 445)4 Street City State Zip Mailing address (if different): Street City State = Zip If more than one plaintiff, list next plaintiff here: Name: Phone: Street address: Street City State Zip Mailing address (if different): Street City State Zip ["] Check here if more than two plaintiffs and attach form SC-I00A. [] Check here if either plaintiff listed above is doing business under a fictitious name. if so, attach form SC-103. (1 Check here if any plaintiff is a “licensee” or “deferred deposit originator” (payday lender) under Financial Code sections 23000 et seq. (2) The defendant(the person, business, or public entity being sued) is: Name: TOG, INC. Phone: Street address: 455 00 Fryeott_B)vd rremoriy Chk 44g ag Street City State Zip Mailing address (if different): Street City State Zip If the defendant is a corporation, limited liability company, or public entity, list the person or agent authorized for service of process here: . Name: € T_COryoraNon sysiem: Job title, if known: Address: DG War Ceventh Qirecy Sie 4 ho Loe 0 ngeles of 400 \|F Jo Am And @ q dir ag City State Zip [1] Check here if your case is against more than one defendant, and attach form SC-100A. [] Check here if any defendant is on active military duty, and write his or her name here: (3) The plaintiff claims the defendant owes $ 3, 70 + . (Explain below): a. Why does the defendant owe the plaintiff money? . _ Eefund of fiooy Verervation par the _Covivact plus lOc} interes} lost fme q eouvt Tega) fees. When did this happen? (Date): Wy 24, WG ~ NOW b. Ifno specific date, give the time period: Date started: Through: c. How did you calculate the money owed to you? Fe not include court costs or fees for service.) _ oo. Hoc Wwservenan; #143 40 initrert (iodo «2.05°/. x F onthe); +2,s00 in lost time (io hou @ ity bilf rate of F 27b))_blut cover ¥ Serving es (Hp) L]} Check here if you need more space. Attach one sheet of paper or form MC-031 and write “SC-100, Item 3” at the top. Revised January 1, 2047 Plaintiff's Claim and ORDER to Go to Small Claims Court SC-100, Page 2 of 5 (Small Claims) >

PDF Page 4	Plamtiff (list names): Case Number: (4) You must ask the defendant (in‘person, in writing, or by phone) to pay you before you sue. If your claim is for possession of property, you must ask the defendant to give you the property. Have you done this? (1 No If no, explain why not: Yes r ot: ae 4 4 . ‘ . ro i Gt 4 tarhhed donvnd fle on Dec it, Dos 7 Feslas itgal det m fremort { Tele wacered aden CT Loiperaheh eysten jh LA: * Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. LC] (1) Where the defendant lives or does business. (4) Where a contract (written or spoken) was made, (2) Where the plaintiff’s property was damaged. signed, performed, or broken by the defendant or (3) Where the plaintiff was injured. where the defendant lived or did business when the defendant made the contract. b. [1] Where the buyer or lessee signed the contract, lives now, or lived when the contract was made, if this claim, is about an offer or contract for personal; family, or household goods, services, or loans. (Code Civ. Proc., $ 395(b),) . c. [1 Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about a retail installment contract (like a credit card). (Civ Code, § 1812.10.) d. [) Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle is permanently garaged, if this claim is about a vehicle finance sale. (Civ Code, § 2984.4.) e. ‘) Other (specify): \| wad? the Hivos reservation oling ib Fachete List the zip code of the place checked in © above (ifyou know): Gd % Is your claim about an attorney-client fee dispute? [] Yes — ° If yes, and if you have had arbitration, fill out form SC-101, attach it to this form, and check here: [] (8) Are you suing a public entity? [] Yes EYNo form is true correct. Revised January 1, 2017 If yes, you must file a written claim with the entity first. {_] A claim was filed on (date): If the public entity denies your claim or does not answer within the time allowed by law, you can file this form. Have you filed more than 12 other smaii claims within the iast 12 months in California? [] Yes No Ifyes, the filing fee for this case will be higher. is your claim for more than $2,5007 ph ves C No If yes, I have not filed, and understand that I canrot file, more than two small claims cases for more than $2,500 in California during this calendar year. l understand that by filing a claim in small claims court, \| have no right to appeal this claim. Date: 4) iG Tanya x dG Cito Plaintiff types or prints name here Date: Second plaintiff types or prints name here Second plaintiff signs here Requests for Accommodations i Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter 4 aservices are available if you ask at least five days before the trial. Contact the clerk’s office for form 2 MC-410, Request for Accommodations by Persons With Disabilities and Response. (Civ. Code, § 54.8.) Plaintiff's Claim and ORDER to Go to Small Claims Court $C-100, Page 3 of 5 (Small Claims) >

PDF Page 5	Tome Tilt) Information for the defendant (the person being sued) "Smail claims court" is a special court where claims for $10,000 or less are decided. Individuals, including "natural persons” and sole proprietors, may claim up to $10,000. Corporations, partnerships, public entities, and other businesses are limited to claims of $5,000. (See below for exceptions.) The process is quick and cheap. The rules are simple and informal. You are the defendani—the person being sued. The person who is suing you Is the plaintiff. Do I need a lawyer? You may talk to a lawyer before or after the case. But you may not have a lawyer represent you in court (unless this is an appeal from a small claims case). How do \| get ready for court? You don’t have to file any papers before your trial, unless you think this is the wrong court for your case. But bring to your trial any witnesses, receipts, and evidence that supports your case. And read “Be Prepared for Your Trial’ at www.courts.ca.gov/smaliclaims/prepare. What if \| need an accommodation? If you have a disability or are hearing impaired, fill out form MC-410, Request for Accommodations. Give the form to your court clerk or the ADA/ Access Coordinator. What if \| don’t speak English well? Ask the court clerk as soon as possible if your court has a court-provided interpreter available and how to request one. A court-provided interpreter may not be available. Alternatively, you may bring an adult who is not a witness or an attomey to interpret for you or ask the court for a list of interpreters for hire. Where can I get the court forms \| need? Go to any courthouse or your county law library, or print forms at www. courts.ca. gov/smaliclaims/forms. What happens at the trial? The judge will listen to both sides. The judge may make a decision at your trial or mail the decision to you later. What if \| lose the case? if you lose, you may appeal. You’ll have to pay a fee. (Plaintiffs cannot appeal their own claims.) » If you were at the trial, file form SC-140, Notice of Appeal. You must file within 30 days after the clerk hands or mails you the judge's decision (judgment) on form SC-200 or form SC-130, Notice of Entry of Judgment. If you were not at the trial, fill out and file form SC-135, Notice of Motion to Vacate Judgment and Declaration, to ask the judge to cancel the judgment (decision). If the judge does not give you a new trial, you have 10 days to appeal the decision. File form SC-140. ’ For more information on appeals, see www.courts.ca.gov/ smailclaims/appeals. Do \| have options? Yes. If you are being sued, you can: - Settle your case before the trial. If you and the plaintiff agree on how to settle the case, the plaintiff must file form CIV-110, Request for Dismissal, with the clerk. Ask the Smail Claims Advisor for help. - Prove this is the wrong court. Send a letter to the court before your trial explaining why you think this is the wrong court. Ask the court to dismiss the claim. You must serve (give) a copy of your letter (by mail or in person) to all parties. (Your letter to the court must say you have done so.) - Go to the trial and try to win your case. Bring witnesses, receipts, and any evidence you need to prove your case. To have the court order a witness to go to the trial, fill out form SC-107 (Smail Claims Subpoena) and have it served on the witness. - Sue the person who is suing you. if you have a claim against the plaintiff, and the claim is appropriate for srnall claims court as described on this form, you may file Defendant's Claim (form SC-120) and bring the claim in this action. If your claim is for more than allowed in small claims court, you may siill file it in smail claims court if you give up the amount over the small claims value amount, or you may file a claim for the full value of the claim in the appropriate court. If your claim is for more than allowed in smail claims court and relates to the same contract, transaction, matter, or event that is the subject of the plaintiff's claim, you may file your claim in the appropriate court and file a motion to transfer the plaintiff's 's claim to that court to resolve both matters together. You can see a description of the amounis aliowed in the paragraph above titled “Small Claims Court.” - Agree with the plaintiff's claim and pay the money. Or, if you can’t pay the money now, go to your trial and say you want to make payments. - Let the case "default." If you don’t settle and do not go to the trial (default), the judge may give the plaintiff wnat he or she is asking for plus court costs. If this happens, the plaintiff can legally take your money, wages, and property to pay the ‘judgment. What if \| need more time? You can change the trial date if: « You cannot go to court on the scheduled date (you will have to pay a fee to postpone the trial), or - You did not get served (receive this order to go to court) at least 15 days before the trial (or 20 days if you live outside the county), or - You need more time to get an interpreter. One postponement is allowed, and you will not have to pay a fee to delay the trial. Ask the Small Claims Clerk about the rules and fees for postponing a trial. Or fill out form SC-150 (or write a letter) and mail it to the court and to all other people listed on your court papers before the deadline. Enclose a check for your court fees, unless a fee waiver was granted. @ f L_ Or go to www.courts.ca.gov/smaliclaims/advisor. Need help? Your county’s Small Claims Advisor can help for free. ~ _\| Exceptions: Different limits apply in an action against a defendant who is a guarantor. (Gee Code Civ. Proc., § 116.220(c).) Revised January 1, 2017 (Smail Plaintiff's Claim and ORDER to Go to Small Claims Court SC-100, Page 4 of 5 —_ Claims)

PDF Page 6	Sometime Informacion para el demandado (la persona demandada) La “Corte de reclamos menores” es una corte especial donde se deciden casos por $10,000 o menos. Los individuos, o sea las “personas fisicas” y los propietatios por cuenta propia, pueden reclamar hasta $10,000. Las corporaciones, asociaciones, entidades plblicas y otras empresas solo pueden reclamar hasta $5,000. (Vea abajo para las excepciones.) El proceso es rapido y barato. Las regias son sencillas ¢ informales. Usted es el Demandado—la persona que se est4 demandando. La persona que lo esta demandando es el Demandanite. éNecesito un abogado? Puede hablar con un abogado antes o después del caso. Pero no puede tener a un abogado que Io represente ante la corte (a menos que se trate de una apelacién de un caso de reclamos menores). 2Cémo me preparo para ir a la corte? No tiene que presentar ningunos papeles antes del juicio, a menos que piense que ésta es la corte equivocada para su caso. Pero lieve al juicio cualquier testigos, recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su juicio” en www.courts.ca.gov/reclamosmenores/preparese. ~Qué hago si necesito una adaptaci6n? Si tiene una discapacidad 0 tiene impedimentos de audicién, llene el formulario MC-410, Request for Accomodations. Entregue el formulario al secretario de la corte o al Coordinador de Acceso/ADA de su corte. 2 Qué pasa si no hablo bien inglés? Pregintele al secretario de la corte lo mas pronto posible si en el juzgado habra un intérprete disponible y cémo solicitarlo. No siempre estan disponibles los intérpretes de la corte. Otra opcién es llevar a un adulto que pueda interpretar para usted siempre que esa persona no sea un testigo ni un abogado. O puede pedir a la corte una lista de intérpretes particulares disponibles para contratar. ¢Dénde puedo obtener ios formularios de la corte que necesito? Vaya a cualquier edificio de la corte, la biblioteca legal de su condado, o imprima los formularios en www.courts.ca.gov/ smaliclaims/forms (pagina esta en inglés). ¢Qué pasa en el juicio? El juez escuchara a ambas partes. EI juez puede tomar su decisién durante la audiencia o enviarsela por correo después. éQué pasa si pierdo el caso? Si pierde, puede apelar. Tendra que pagar una cuota. (El Demandante no puede apelar su propio reclamo.) . Si estuvo presente en el juicio, lene el formulario SC-140, Aviso de apelacidn (Notice of Appeal). Tiene que presentarlo dentro de 30 dias después de que el secretario le entregue o envie fa decisién (fallo) del juez en el formulario SC-200 o SC-130, Aviso de publicacién del fallo (Notice of Entry of Judgment). . Sino estuvo en el juicio, Ilene y presente el formulario SC-135, Aviso de peticién para anular el fallo y Declaracién para pedirle at juez que anule el fallo (decisi6n). Si la corte no le otorga un nuevo juicio, tiene 10 dias para apelar la decision. Presente el formulatio SC-140. Para obtener mas informacién sobre las apelaciones, vea www. courts.ca.gov/reclamosmenores/apelaciones. é Tengo otras opciones? Si. Si lo estan demandando, puede: . Resolver su caso antes de! juicio. Si usted y el Demandante se ponen de acuerdo en cémo resolver el caso, el Demandante tiene que preseniar el formulario CiV-110, Solicitud de desestimacién (Request for Dismissal) ante el secretario de la corte. Pidale al Asesor de Reciamos Menores que lo ayude. . Probar que es la corte equivocada. Envie una carta a !a corte antes del juicio explicando por qué cree que es Ia corte equivocada, Plidale a la corte que despida el reclamo.Tiene que entregar (dar) una copia de su carta (por correo o en persona) a todas las partes. (Su carta a la corte tiene que decir que hizo la entrega.) . lraljuicio y tratar de ganar el caso. Lleve testigos, recibos y cualquier prueba que necesite para probar su caso. Si desea que la corte emita una orden de comparecencia para que los testigos vayan al juicio, llene el formutario SC-107, Citatorio de reclamos menores (Small Claims Subpoena) y entrégueselo legalmente al testigo. . Demandar a la persona que lo demandé6. Si tiene un reclamo contra el Demandante, y el reclamo se puede presentar en fa corte de reclamos menores, tal como se describe en este formulario, puede presentar el formulario SC-120, Reclamo def demandado (Defendant's Claim) y presentario en este mismo caso. Si su reclamo excede el limite permitido en la corte de reclamos menores, puede igualmente presentarlo en fa corte de reclamos menores si esta dispuesto a limitar su reclamo al maximo permitido, o puede presentar un reclamo por el monto total en la corte apropiada. Si su reclamo excede el Ifmite permitido en la corte de reclamos menores y esta relacionado con el mismo contrato, transaccién, asunto o acontecimiento que el reclamo del Demandante, puede presentar su reclamo en fa corte apropiada y presentar una mocién para transferir el reclamo del Demandante a dicha corte, pata poder resolver los dos reclamos juntos. Puede ver una descripcién de los montos permitidos en el parrafo anterior titulado “Corte de reclamos menores’. . Aeptar el reciamo del Demandante y pagar el dinero. O, si no puede pagar en ese momento, vaya al juicio y diga que quiere hacer los pagos. No ir al juicio y aceptar el fallo por falta de comparecencia. Si no llega a un acuerdo con el Demandante y no va al juicio (fallo por falta de comparecencia), el juez le puede otorgar al Demandante lo que esta reclamando mas Jos costos de Ia corte. En ese caso, el Demandante legalmente puede tomar su dinero, su sueldo o sus bienes para cobrar el fallo. 2Qué hago si necesito mas tiempo? Puede cambiar fa fecha del juicio si: » No puede ir a la corte en la fecha programada (tendraé que pagar una cuota para aplazar el juicio), o ¢ No le entregaron los documentos legalmente (no recibié la orden para ir a la corte) por lo menos 15 dias antes del juicio (6 20 dias si vive fuera del condado)}, o Necesita mas tiempo para conseguir intérprete. (Se permite un solo aplazamiento sin tener que pagar cuota para aplazar el uicio). pregintale al secretario de reclammos menores sobre las reglas y las cuotas para aplazar un juicio. O Hlene el formulario SC-150 (© escriba una carta) y envielo antes del plazo a !a corte y a todas las otras personas que figuran en sus papeles de la corte. Adjunte un cheque para pagar los costos de la corte, a menos que le hayan dado una exencion. éNecesita ayuda? E! Asesor de Reclamos Menores de su condado le puede ayudar sin cargo. _\| O visite www.courts.ca.gov/reclamosmenores/asesores. * Excepciones: Existen diferentes limites an un reclamo contra un garante. (Vea el Codigo de Procedimiento Civil, seccién 116.220 (c).) Revised January 1, 2017 Reclamo del Demandante y ORDEN SC-100, Page 5 of 5 Para Ir ala Corte de Reclamos Menores (Reclamos Menores)


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