Page 1 Name and Address
of Cour!
SC-
SUPERIOR COURT 0F CALIFORNI
COUNTY OF SANTA CLARA
191 North First Street
San José.
California 951
SMALL CLAIMS CASE NO.: 21SCAVISO A TODOS LOS DEMANDANTES YDEMANDADOS:
NOTICE TO ALL PLAINTIFFS AND DEFENDANTS:
Your small claims case has been decided. If you lost the
case, and the court ordered you to pay money, your
wages, money, and property may be taken without further
warnlng from the court. Read the back of this sheet for
important infomation about your rights.
/PLAINTIFFIDEMANDANTE
(Name, fires! sddrEss,
Su caso ha sido resuelto por
la
corte para reclamos
en su contra y
ha ordenado que usted pague dinero, Ie pueden quitar su
salario, su dinero, y otras cosas de su propiedad. sln aviso
adicional por parte de esta corte. Lea el reverse de este
formulario para obtener infomacién de importancla acerca
de sus derechos.
judiciales menores. Si la corte ha decidido
DEFENDANT/DEMAN DADO' (Name,
aw telephone number of each):
street address,
and telephone number of each):
Tina Lewis
172 Louisburg Street
TESLA. INC.
Which Will Do Business
SAN FRANCISCO CA
Tesla Motors, Inc.
SO: CT Corporation System [Agent
330 N. Brand Boulevard, Suite #
GLENDALE CA
As:
In California
I
Service
I
Process
91
/Brian
0n
D
See attached sheet
for additional plaintiffs
Judgment was entered as checked below
D
DD
EDD
/
[Date of Hearing: 10/14/2021 830am D15]
and defendants
Hon. Commissioner Christine Copeland
Hearing Officer:
Irwin, A Business Resolution Partner, Appears
Behalf 0f The Corporate! Defendant.
NOTICE OF ENTRY 0F JUDGMENT
[
]
on: 10f14/
Defendant (name, ifmore than one):
shall pay plaintiff (name, if more than one):
costs on plaintiffs claim.
principal and: $
Defendant does not owe plaintiff any money on plaintiff‘s claim.
Plaintiff (name, ifmore than one):
shall pay defendant (name, ffmore than one):
costs on defendant's claim.
principal and:$
$
Plaintiff does not owe defendant any money on defendant's claim
Possession of the foltowing property is awarded to plaintiff (describe property):
and on the (specify
beginning on (date.
per (specify period):
Payments are to be made at the rate of: $
day of each month thereafter until paid in full‘ If any payment is missed, the entire balance may become
day):
'
due immediately.
:tm.
_..--';
gwithout prejudice
Dlsmissed in
Aflomey-Ch‘ent Fee Dispute (AUachment to oh’ce ofEntry of Judgment) (form 50—132) is attached.
CASE is therefore
Plaintiff decides to file Dismissal Form #SC-SOO? with the Court.
Other (specify):
DISMISSED WITHOUT PREJUDICE, as stated on the record. Written Notice To Both Parties via U.S. Mail
This judgment results from a motor vehicle accident on a California highway and was caused by the judgment debtor‘s operation of
judgment is not paid. the judgment creditor may apply to have the judgment debtor’s driver‘s
the
If
a
motor vehicle.
--
_
e.
1o.
D
11.
license suspended.
Enforcement ofthe judgment
D
is
.
automatically postponed for 30 days
or,
if
an appeal
filed. until the appeal
is
is
decided.
was personally delivered to (insert name and dare):
CERTIFICATE OF MAILING—l certify that am not a party
This notice
@LERK‘S
postage
to this action. This Notice of Entry of Judgment was mailed first
a seaied envelope to the parties at the addresses shown above The mailing and this certification occurred at
the place and on the date shown below.
class.
@
l
prepaid,
Place
Da
in
mailing:
ofmailin.
San Jose,California
10l.
Deputy
Kathy Davidson
The county provides small claims adviser services
free of charge.
Read the information sheet on the
gm“
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.
.,
.
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w
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K‘,
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Adopted
for
Ahemative Mandatory Use
Judicial Council of California
80-130 [Rev
July
1,
2010]
F
VF;
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NOTICE OF ENTRY 0F JUDGMENT
(Small Claims)
t
I..’
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of Civil Procedures §1 16.
wmw/murfin/ocagovPage 2 SC-
INFORMATION AFTER JUDGMENT
INFORMACION DESPUES DEL FALLO DE LA CORTE
Your smalt claims case has been decided. The judgment or decision ofthe court appears on the front of this sheet. The court may
have ordered one party to pay money to the other party. The person (or business) who won the case and who can collect the money
is called the judgment creditor. The person (or business) who lost the case and who owes the money is called the judgment
'
debtor.
Enforcement of thejudgment is postponed until the time for appeal ends or until the appeal is decided. This means that the judgment
creditor cannot collect any money or take any action until this period is over. Generally. both patties may be represented by lawyers
afterjudgment.
IF
1.
YOU LOST THE CASE
.
b.
..
you lost the case on your own claim and the court did not
award you any money, the court‘s decision on your claim is
FINAL. You may not appeal your own claimA
If you lost the case and the court ordered you to pay money,
your money and property may be taken to pay the claim unless
you do one ofthe following things:
a.
for
THE COURT WILL NOT COLLECT THE
MONEY 0R ENFORCE THE JUDGMENT FOR YOU.
c,
amount
APPEAL
ORDER OF EXAMINATION
Notice of Appea! (form 80-140) and pay the required fees
30 days afler the date this Notice of Entry of
come
You may
Judgment was maited or handed to you. Your appeal will be
in the superior court. You will have a new trial and you must
present your evidence again. You may be represented by a
questions about income and property. To do this. ask the
clerk for an Application and Order for Appearance and
Examination (Enforcement of Judgment) (form EJ-125) and
pay the required fee. There is a fee if a law officer serves the
order on the judgment debtor. You may also obtain the
VACATE OR CANCEL THE JUDGMENT
you may ask the coun to vacate
To make this request. you must file
a Motion to Vacate the Judgment (form 80-135) and pay the
required fee within 30 days afier the date this Notice of Entry
ofJudgment was mailed. 1f your request is denied, you then
have 10 days from the date the notice of denial was maited
to fife an appeaL The period to fire the Motion to Vacate the
Judgment is 180 days if you were not pmpeny served with
the claim. The 180—day period begins on the date you found
lfyou did not go to the
out or should have found out about the judgment against
you.
YOU WON THE CASE.
..
If you were sued by the other patty and you won
the other party may not appeal the court's decision.
If you won the case and the court awarded you money, here are
some steps you may take to collect your money or get
the case, then
possession of your property:
COLLECTING FEES AND INTEREST
clerk for a
Memorandum
NOTICE TO THE PARTY
immediately or you
proper form.
will
.
the debtor
to court to
answer
WRIT OF EXECUTION
Afler you find out about the judgment debtors
property. you
the court for a Wn’t of Execution (form EJ-TBO) and
pay the required fee. A writ of execution is a court paper that
tells a law officer to take property of the judgment debtor to
pay your claim. Here are some examples of the kinds of
property the officer may be able to take: wages, bank
may ask
account. automobile, business property. or rental income
For some kinds of property. you may need to file other forms.
See the law officer
for information.
ABSTRACT OF JUDGMENT
The judgment debtor may own
buildings. You may want to put a
land or a house or other
on the property so that
You can get a lien by
filing an Abstract of Judgment (form EJ-001) with the county
recorder in the county where the property Is located. The
recorder will charge a fee for the Abstract ofJudgment.
you
Sometimes fees are charged for filing court papers or for
sewing the judgment debtor. These extra costs can become
part of your original judgment. To claim these fees, ask the
also
judgment debtors financial records. Ask the clerk for the Small
Claims Subpoena and Declaration (form 80-107) or Civil
Subpoena Duces Tecum (form SUBP-OOZ).
trial,
or cancel the judgment.
a.
make
within
lawye r.
2.
tell
you what property the judgment debtor has that may be
available to pay your claim. If the judgment debtor willfully
fails to send you the completed form. you may file an
Application and Order to Produce Statement ofAssets and Io
Appear for Examination (form SC-1 34) and ask the court to
give you your attorney's fees and expenses and other
appropriate relief, afler proper notice, under Code of Civil
Procedure section 708.
decision on your own claim. However, if any party appeals,
there will be a new trial on allthe claims If you appeared at
the trial, you must begin your appeal by filing a form called a
1.
judgment debtor does not pay the money, the law
requires the debtor to fill out a form called the Judgment
Debtor’s Statement ofAssets (form 80-133). This form will
of the judgment.
If you disagree with the court's decision, you may appeal the
decision on the other party‘s claim, You may not appeal the
1F
STATEMENT OF ASSETS
Ifthe
the
creditor directly. or pay the
judgment to the court for an additional fee. You may also
ask the court to order monthly payments you can afford.
Ask the clerk for information about these procedures
c.
to pay the money. If your ciaim was
possession of property, ask the judgment debtor to return
the property to you.
PAY THE JUDGMENT
The law requires you to pay
You may pay the judgment
b.
VOLUNTARY PAYMENT
Ask the judgment debtor
If
will
be paid
if
the property
is
lien
sold.
of Costs.
WHO WON:
be finedl
If
As soon as you have been paid in full, you must fill out the form below and mail itto the court
an Abstract of Judgment has been recorded, you must use another form; see the cIerk for the
SMALL CLAIMS
NO.:
218C
ACKNOWLEDGEMENT OF SATISFACTION OF JUDGMENT
(Do not use
To the
|
|
am
this
fonn
if
an Abstract of Judgment has been received.)
Clerk of the Court:
the
D judgment creditor
agree that the judgment
D assignee of record.
in this
action has
been paid
1n full
or otherwise satisfied.
Date:
(TYPE
SC-130 [Rev
July
1,
2010]
OR PRINT NAME)
>
NOTICE OF ENTRY 0F JUDGMENT
(Small Claims)
(SIGNATURE)
Page 2 ofPage 3 '
g
ATTACHMENT 50-
‘
T;
F
su ERIOR COURT 0F CALIFORNIA, COUNTY 0F SANTA CLARA
D
DOWNTOWN COURTHOUSE'
191 NORTH FIRST STREET
SAN JOSECA
j
U
PALO ALTO COURTHOUSE
270 GRANT AVENUE
PALO ALTO.CA
“W
O“
-....-.-
SOUTH COUNTY COURTHOUSE
301 DIANA AVENUE
MORGAN HILL, CA
-'
'
.
—"
3"
,1.
_
OCT
PLAINTIFF/PETITIONERZ
1 4
'—
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fthe Court
la
DEFENDANT/RESPONDENTI
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CASE NUMBER:
REQUEST FOR DISMISSAL (SMALL CLAIMS)
If
you
case before trial. you must
days prior to hearing date.
settle the
(three) court
TO THE CLERK:
1.
D
file
(may
a dismissal with the
not file again)
D
3,
"d "H“
g
‘
;K5Q_ OJb/«ODQE?
clerk.
Please dismiss the Claim of Plaintiffr'Petitioner as
\Nlth prejudice
Clara
DEPUTY
Please
follows:
file
your dismissal
at least
(check applicable box)
Partial dismissal (for multiple
Defendants/Respondents)
Dismiss only as to
a)
b)
)0-
If
With prejudice (may not file again)
Without prejudice (may file again)
x
\ZOWL,
b
0R PRINT NAME)
(SIGNATURE 0F PIJWTIFFIFBTITIONER)
a claim of Defendant/Respondent has been filed, the Defendant/Respondent
TO THE CLERK:
1.
/
/1/\)OQ(
(TYPE
D
D
D
D
dismiss their action as follows:
Piease dismiss the Claim 0f Defendanthespondent as follows: (check applicable box)
Wlth prejudice (may not file again)
3.
D
Partial dismissal (for multiple PlaintiffsfPetitioners)
Dismiss only as
2.
may
Wlthout prejudice (may file again)
a)
b)
D
D
to
L.)
With prejudice (may n’ofltrqjéqgn)
Without prejudic _fi'ay file again)
Date:
(TYPE
NOTE:
In
some
OR PRINT NAME)
(SIGNATURE OF PLAINTIFF/PETTFIONER)
‘
faciliiies,
if
there
is
a Claim of PI
IfffPetJtioner
lhe hearing. the party who wants to file [he di
saf should file
clerk al the Courthouse where your claimi
ed for clarification,
85-
REV 7/01/
AND
it
in
a Claim of Defendant. and only one party wants to file a dismissal prior to
when appearing on the other claim in the case. Check with the
the Court
REQUEST FOR DISMISSAL (SMALL CLAIMS)
Page
af1
PDF Page 1
PlainSite Cover Page
PDF Page 2
Name and Address
of Cour!
SC-130
SUPERIOR COURT 0F CALIFORNI
COUNTY OF SANTA CLARA
191 North First Street
San José.
California 951 13
SMALL CLAIMS CASE NO.: 21SC085858
AVISO A TODOS LOS DEMANDANTES YDEMANDADOS:
NOTICE TO ALL PLAINTIFFS AND DEFENDANTS:
Your small claims case has been decided. If you lost the
case, and the court ordered you to pay money, your
wages, money, and property may be taken without further
warnlng from the court. Read the back of this sheet for
important infomation about your rights.
/PLAINTIFFIDEMANDANTE
(Name, fires! sddrEss,
Su caso ha sido resuelto por
la
corte para reclamos
en su contra y
ha ordenado que usted pague dinero, Ie pueden quitar su
salario, su dinero, y otras cosas de su propiedad. sln aviso
adicional por parte de esta corte. Lea el reverse de este
formulario para obtener infomacién de importancla acerca
de sus derechos.
judiciales menores. Si la corte ha decidido
DEFENDANT/DEMAN DADO' (Name,
aw telephone number of each):
street address,
and telephone number of each):
Tina Lewis
172 Louisburg Street
TESLA. INC.
Which Will Do Business
SAN FRANCISCO CA 94112
Tesla Motors, Inc.
SO: CT Corporation System [Agent
330 N. Brand Boulevard, Suite #700
GLENDALE CA
As:
In California
I
Service
I
Process
91 203
/Brian
0n
D
See attached sheet
for additional plaintiffs
Judgment was entered as checked below
D
2
DD
3
4
5
6
EDD
/
[Date of Hearing: 10/14/2021 830am D15]
and defendants
Hon. Commissioner Christine Copeland
Hearing Officer:
1
Irwin, A Business Resolution Partner, Appears
Behalf 0f The Corporate! Defendant.
NOTICE OF ENTRY 0F JUDGMENT
[
]
on: 10f14/2021
Defendant (name, ifmore than one):
shall pay plaintiff (name, if more than one):
costs on plaintiffs claim.
principal and: $
Defendant does not owe plaintiff any money on plaintiff‘s claim.
Plaintiff (name, ifmore than one):
shall pay defendant (name, ffmore than one):
costs on defendant's claim.
principal and:$
$
Plaintiff does not owe defendant any money on defendant's claim
Possession of the foltowing property is awarded to plaintiff (describe property):
and on the (specify
beginning on (date.
per (specify period):
Payments are to be made at the rate of: $
day of each month thereafter until paid in full‘ If any payment is missed, the entire balance may become
day):
'
due immediately.
:tm.
_..--';
gwithout prejudice
Dlsmissed in
Aflomey-Ch‘ent Fee Dispute (AUachment to oh’ce ofEntry of Judgment) (form 50—132) is attached.
CASE is therefore
Plaintiff decides to file Dismissal Form #SC-SOO? with the Court.
Other (specify):
DISMISSED WITHOUT PREJUDICE, as stated on the record. Written Notice To Both Parties via U.S. Mail
This judgment results from a motor vehicle accident on a California highway and was caused by the judgment debtor‘s operation of
judgment is not paid. the judgment creditor may apply to have the judgment debtor’s driver‘s
the
If
a
motor vehicle.
--
_
e.
1o.
D
11.
license suspended.
Enforcement ofthe judgment
1
4
D
is
.
automatically postponed for 30 days
or,
if
an appeal
filed. until the appeal
is
is
decided.
was personally delivered to (insert name and dare):
CERTIFICATE OF MAILING—l certify that am not a party
This notice
@LERK‘S
postage
to this action. This Notice of Entry of Judgment was mailed first
a seaied envelope to the parties at the addresses shown above The mailing and this certification occurred at
the place and on the date shown below.
class.
@
l
prepaid,
Place
Da
in
mailing:
ofmailin.
San Jose,California
10l1412021
.
Deputy
Kathy Davidson
The county provides small claims adviser services
free of charge.
Read the information sheet on the
gm“
"‘
”q
.
.,
.
.,
‘
w
‘
p
’91
"fc‘,
:»
A
‘
’
reverse.
;'
IL
I
~.
l
1-:
,d.
2‘1
K‘,
L‘-
K-
kg;
Fon'n
Adopted
for
Ahemative Mandatory Use
Judicial Council of California
80-130 [Rev
July
1,
2010]
F
VF;
f
i.
..
r
g
'1
1;,
.
L
'.'._
3i
~‘
'_.
x_-
NOTICE OF ENTRY 0F JUDGMENT
(Small Claims)
t
I..’
f
I
u
4f
.
_
‘,
_
y_
4‘
_
3“
‘-'
x:
v
‘
.'
-_
;
Code
arr:
r\
"
11]«
3‘
‘\
,_
..
A
.~
r
~_»_“:'.'J
of Civil Procedures §1 16.610
wmw/murfin/ocagov
PDF Page 3
SC-130
INFORMATION AFTER JUDGMENT
INFORMACION DESPUES DEL FALLO DE LA CORTE
Your smalt claims case has been decided. The judgment or decision ofthe court appears on the front of this sheet. The court may
have ordered one party to pay money to the other party. The person (or business) who won the case and who can collect the money
is called the judgment creditor. The person (or business) who lost the case and who owes the money is called the judgment
'
debtor.
Enforcement of thejudgment is postponed until the time for appeal ends or until the appeal is decided. This means that the judgment
creditor cannot collect any money or take any action until this period is over. Generally. both patties may be represented by lawyers
afterjudgment.
IF
1.
YOU LOST THE CASE
.
b.
..
you lost the case on your own claim and the court did not
award you any money, the court‘s decision on your claim is
FINAL. You may not appeal your own claimA
If you lost the case and the court ordered you to pay money,
your money and property may be taken to pay the claim unless
you do one ofthe following things:
a.
for
THE COURT WILL NOT COLLECT THE
MONEY 0R ENFORCE THE JUDGMENT FOR YOU.
c,
amount
APPEAL
ORDER OF EXAMINATION
Notice of Appea! (form 80-140) and pay the required fees
30 days afler the date this Notice of Entry of
come
You may
Judgment was maited or handed to you. Your appeal will be
in the superior court. You will have a new trial and you must
present your evidence again. You may be represented by a
questions about income and property. To do this. ask the
clerk for an Application and Order for Appearance and
Examination (Enforcement of Judgment) (form EJ-125) and
pay the required fee. There is a fee if a law officer serves the
order on the judgment debtor. You may also obtain the
VACATE OR CANCEL THE JUDGMENT
you may ask the coun to vacate
To make this request. you must file
a Motion to Vacate the Judgment (form 80-135) and pay the
required fee within 30 days afier the date this Notice of Entry
ofJudgment was mailed. 1f your request is denied, you then
have 10 days from the date the notice of denial was maited
to fife an appeaL The period to fire the Motion to Vacate the
Judgment is 180 days if you were not pmpeny served with
the claim. The 180—day period begins on the date you found
lfyou did not go to the
out or should have found out about the judgment against
you.
YOU WON THE CASE.
..
If you were sued by the other patty and you won
the other party may not appeal the court's decision.
If you won the case and the court awarded you money, here are
some steps you may take to collect your money or get
the case, then
possession of your property:
COLLECTING FEES AND INTEREST
clerk for a
Memorandum
NOTICE TO THE PARTY
immediately or you
proper form.
will
.
the debtor
to court to
answer
WRIT OF EXECUTION
Afler you find out about the judgment debtors
property. you
the court for a Wn’t of Execution (form EJ-TBO) and
pay the required fee. A writ of execution is a court paper that
tells a law officer to take property of the judgment debtor to
pay your claim. Here are some examples of the kinds of
property the officer may be able to take: wages, bank
may ask
account. automobile, business property. or rental income
For some kinds of property. you may need to file other forms.
See the law officer
for information.
ABSTRACT OF JUDGMENT
The judgment debtor may own
buildings. You may want to put a
land or a house or other
on the property so that
You can get a lien by
filing an Abstract of Judgment (form EJ-001) with the county
recorder in the county where the property Is located. The
recorder will charge a fee for the Abstract ofJudgment.
you
Sometimes fees are charged for filing court papers or for
sewing the judgment debtor. These extra costs can become
part of your original judgment. To claim these fees, ask the
also
judgment debtors financial records. Ask the clerk for the Small
Claims Subpoena and Declaration (form 80-107) or Civil
Subpoena Duces Tecum (form SUBP-OOZ).
trial,
or cancel the judgment.
a.
make
within
lawye r.
2.
tell
you what property the judgment debtor has that may be
available to pay your claim. If the judgment debtor willfully
fails to send you the completed form. you may file an
Application and Order to Produce Statement ofAssets and Io
Appear for Examination (form SC-1 34) and ask the court to
give you your attorney's fees and expenses and other
appropriate relief, afler proper notice, under Code of Civil
Procedure section 708.1704
decision on your own claim. However, if any party appeals,
there will be a new trial on allthe claims If you appeared at
the trial, you must begin your appeal by filing a form called a
1.
judgment debtor does not pay the money, the law
requires the debtor to fill out a form called the Judgment
Debtor’s Statement ofAssets (form 80-133). This form will
of the judgment.
If you disagree with the court's decision, you may appeal the
decision on the other party‘s claim, You may not appeal the
1F
STATEMENT OF ASSETS
Ifthe
the
creditor directly. or pay the
judgment to the court for an additional fee. You may also
ask the court to order monthly payments you can afford.
Ask the clerk for information about these procedures
c.
to pay the money. If your ciaim was
possession of property, ask the judgment debtor to return
the property to you.
PAY THE JUDGMENT
The law requires you to pay
You may pay the judgment
b.
VOLUNTARY PAYMENT
Ask the judgment debtor
If
will
be paid
if
the property
is
lien
sold.
of Costs.
WHO WON:
be finedl
If
As soon as you have been paid in full, you must fill out the form below and mail itto the court
an Abstract of Judgment has been recorded, you must use another form; see the cIerk for the
SMALL CLAIMS
NO.:
218C085358
ACKNOWLEDGEMENT OF SATISFACTION OF JUDGMENT
(Do not use
To the
|
|
am
this
fonn
if
an Abstract of Judgment has been received.)
Clerk of the Court:
the
D judgment creditor
agree that the judgment
D assignee of record.
in this
action has
been paid
1n full
or otherwise satisfied.
Date:
(TYPE
SC-130 [Rev
July
1,
2010]
OR PRINT NAME)
>
NOTICE OF ENTRY 0F JUDGMENT
(Small Claims)
(SIGNATURE)
Page 2 of2
PDF Page 4
'
g
ATTACHMENT 50-8007
‘1
T;
F
su ERIOR COURT 0F CALIFORNIA, COUNTY 0F SANTA CLARA
D
DOWNTOWN COURTHOUSE'
191 NORTH FIRST STREET
SAN JOSECA 55113
j
U
PALO ALTO COURTHOUSE
270 GRANT AVENUE
PALO ALTO.CA 84305
“W
O“
-....-.-
SOUTH COUNTY COURTHOUSE
301 DIANA AVENUE
MORGAN HILL, CA 95037
-'
'
.1
—"
3"
,1.
_
OCT
PLAINTIFF/PETITIONERZ
1 4 2021
'—
L/eifiw \5
fthe Court
la
DEFENDANT/RESPONDENTI
-"
\Jfi KR “keisf “s
;Q“\T}J‘J
r‘I-f‘
‘z
Ilr'sf‘f‘n
-
CASE NUMBER:
REQUEST FOR DISMISSAL (SMALL CLAIMS)
If
you
case before trial. you must
days prior to hearing date.
settle the
(three) court
TO THE CLERK:
1.
D
file
(may
a dismissal with the
not file again)
D
3,
"d "H“
g
‘
;K5Q_ OJb/«ODQE?
clerk.
Please dismiss the Claim of Plaintiffr'Petitioner as
\Nlth prejudice
Clara
DEPUTY
Please
follows:
file
your dismissal
at least 3
(check applicable box)
Partial dismissal (for multiple
Defendants/Respondents)
Dismiss only as to
a)
b)
)0-
If
With prejudice (may not file again)
Without prejudice (may file again)
x
\ZOWL,
b
0R PRINT NAME)
(SIGNATURE 0F PIJWTIFFIFBTITIONER)
a claim of Defendant/Respondent has been filed, the Defendant/Respondent
TO THE CLERK:
1.
/
/1/\)OQ(
(TYPE
D
D
D
D
dismiss their action as follows:
Piease dismiss the Claim 0f Defendanthespondent as follows: (check applicable box)
Wlth prejudice (may not file again)
3.
D
Partial dismissal (for multiple PlaintiffsfPetitioners)
Dismiss only as
2.
may
Wlthout prejudice (may file again)
a)
b)
D
D
to
L.)
With prejudice (may n’ofltrqjéqgn)
Without prejudic _fi'ay file again)
Date:
(TYPE
NOTE:
In
some
OR PRINT NAME)
(SIGNATURE OF PLAINTIFF/PETTFIONER)
‘
faciliiies,
if
there
is
a Claim of PI
IfffPetJtioner
lhe hearing. the party who wants to file [he di
saf should file
clerk al the Courthouse where your claimi
ed for clarification,
85-3007
REV 7/01/09
AND
it
in
a Claim of Defendant. and only one party wants to file a dismissal prior to
when appearing on the other claim in the case. Check with the
the Court
REQUEST FOR DISMISSAL (SMALL CLAIMS)
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