NoticeCal. Super. - 6th Dist.December 5, 2017KOOOQO 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 E-FILED BRIAN J. STRETCH (CABN 163973) - 1I5/2018 11:21 AM United States Attorney Clerk of Court SARA WINSLOW (DCBN 457643) Superior Court of CA, Chief, Civil Division County of Santa Clara CLAIRE T. CORMIER (CABN 154364) , - 17SC072064 Asslstdnt Unlted States Attorney Reviewed By: D. Dagnino US. Attorney’s Office/Civil Division Envelope=1106903 150 Almaden Blvd., Suite 900 San Jose, CA 95113 Telephone: (408) 535-5082 Fax: (408) 535-5081 Email: claire.connier@usdoj . gov Attorney for Federal Defendant United States Postal Service SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CLARA SMALL CLAIMS JURISDICTION WILLIAM VIRAY, NATIVIDAD ) Filing Fees Exempt For Federal Government NAVARRO VIRAY, ' ) Pursuant to GC6103 ) Plaintiffs, ) CASE NO. 17SC072064 ; V. ) NOTICE OF REMOVAL OF CIVIL ACTION UNITED STATES POSTAL SERVICE, ) KAISER PERMANENTE, STEPHEN ) MERITT RAFFLE, ) ) Defendants. ) ) T0: Clerk, Superior Court of California County of Santa Clara Downtown Superior Court 191 North First Street San Jose, CA 95113 PLEASE TAKE NOTICE that 011 this day Case N 0. 17SC072064 pending before Santa Clara County Superior Court, Small Claims Jurisdiction is being removed to the United States District Court Notice of Removal of Civil Action Vimy, et a]. v. United States Postal Service, et al. Case No. 17SC072064 \DOO\l0\ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 for the Northern Distn'ct of California pursuant to 28 U.S.C. §§1441(a), 1442 (a)(l ), and 1446(d) on behalf of Federal Defendant United States Postal Service. The filing of the Notice of Removal of Civil Action in the United States District Court effects removal of this action from state court. No further proceedings in this action before the state court are allowed unless and until the action is remanded by the United States District Court. A true copy of this Notice of Removal of Civil Action filed in the United States District Court is attached hereto as Exhibit 1. Respectfully Submitted, BRIAN J. STRETCH United States Attorney /_/ CLAIRE T. CORMIER Assistant United States Attorney Attorneys for Federal Defendant USPS Dated: January 5, 2018 > By: Notice of Removal of Civil Action Viray, et al. v. United States Postal Service, et al. Case No. I 7SC072064 ©00\}O\ 1o 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CERTIFICATE OF SERVICE William Virav, et al. v. United States Postal Services. et a]. Santa Clara Sup. Ct/Small Claims # 17SC072064 USDC Case # 5:18-cv-00099 The undersigned hereby certifies that she is an employee of the Office of the United States Attorney for the Northern District of California and is a person of such age and discretion to be competent to serve papers. The undersigned further certifies that she is causing a copy of the following: 1. Notice of Removal of Civil Action with Exhibit 1. to be served this date upon the party in this action by placing a true copy thereof in a sealed envelope, and served as follows: [X] FEDERAL EXPRESS via Priority Overnight [] EMAIL by mutual agreement of the parties to the pafly(ies) addressed as follows: Representing Pro Se Plaintiffs William & Natividad Viray: William Viray, Pro Se Plf. 133 Vargas Court Milpitas, CA 95035 PH: 408.834.3787 wviray@mail.ccsf.edu Representing Pro Se Plaintiffs William & Natividad Viray: Natividad Navarro Viray, Deceased Plf. c/o William Viray, Pro Se Plf. 45 Park Victoria # 118 Milpitas, CA 95035 PH: 408.834.3787 wviray@mail.ccsf.edu Kaiser Permanentc c/o Debra Contreras, Medical Legal Rep. 770 East Calavcras Blvd. Milpitas, CA 95035 PH: 408.851.4167 Representing Defendant Kaiser Permanentc: Representing Defendant Stephen M. Raffle: Stephen M. Raffle 45 Wolfe Grade Kentfield, CA 94904 Counsel for Defendant Stephen M. Raffle: Kevin P. Kelly, Esq. The Goldman Law Firm 55 Main Street Tiburon, CA 94920 PH: 415.435.5500/FX: 4154355156 kkclly@goldmanlawfirm.net Clerk, Superior Court of California County of Santa Clara Downtown Superior Com“: 191 North First Street San Jose, CA 95113 (*Service through e-filing system using Court Approved Odyssey eFiIeCA) I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Executed on January 5, 2018 at San Francisco, Qalifomia. flat LILY HO-VUONG, Paralegal Specialist Assistant to Claire T. Connier, AUSA Natice of Removal of Civil Action Viray, et al. v. United States Postal Service, et a]. Case No. 1 7SC072064 EXHIBIT 1 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Case 5:18-cv-00099 Document 1 Filed 01/05/18 Page 1 of 4 BRIAN J. STRETCH (CABN 163973) United States Attorney SARA WINSLOW (DCBN 457643) Chief, Civil Division CLAIRE T. CORMIER (CABN 154364) Assistant United States Attorney US. Attorney’s Office/Civil Division 150 Almaden Blvd., Suite 900 San Jose, CA 95113 Telephone: (408) 535-5082 Fax: (408) 535-5081 Email: claire.cormier@usdoj .gov Attorney for Federal Defendant United States Postal Service UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALTFORNIA SAN JOSE DIVISION WILLIAM VIRAY, NATIVIDAD NAVARRO VIRAY, CASE NO. Plaintiffs, V. NOTICE OF REMOVAL OF CIVIL ACTION UNITED STATES POSTAL SERVICE, KAISER PERMANENTE, STEPHEN MERITT RAFFLE, Defendants. ) ) ) ) ) ) ) ) ) ) ) ) ) TO: United States District Court for the Northern District of California Clerk, Superior Court of California County of Santa Clara Downtown Superior Court 191 North First Street San Jose, CA 95113 PLEASE TAKE NOTICE that on this day Case No. 17SC072064 pending before the Santa Clara County Superior Court is being removed to the United States District Court for the Northern District of NOTICE OF REMOVAL U SDC Case No. \DOO\]O\ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Case 5:18-cv-00099 Document 1 Filed 01/05/18 Page 2 0f 4 California pursuant to 28 U.S.C. § 1441(a), and 1442(a)(1) on behalf of Federal Defendant United States Postal Service (hereinafter “Federal Defendant”). Upon direction by the Attorney General of the United States and pursuant to 28 U.S.C. § 1446, the undersigned attorneys hereby present the following facts to the Judges ofthc United States District Court for the Northern District of California. 1. William Viray, on his own behalf and on behalf of Natividad Navarro Viray, deceased, (hereinafter “Plaintiffs”) filed a Plaintiffs Claim and ORDER to Go to Small Claims Court (“Complaint”) on December 5, 2017 in the Santa Clara County Superior Court against Defendant. Though the Complaint allegations are not entirely clear, William Viray alleges that an incident occurred in August of 2009 relating to “unconsented two documents that have scribble lines,” rather an “real signatures.” He demands lost wages, is “demanding of the death of my grandmother,” and “demanding of violation rights and privacy.” He also demands that unspecified persons “should be in prison, lifetime.” He is also “demanding to clear [his] medical record.” Plaintiff demands in excess of $10,000. The Complaint names as defendants the United States Postal Service, Kaiser Permanente, and Stephen Meritt Raffle. 2. On or about December 8, 2017, the United States Attorney’s Office received a copy of the Complaint from the United States Postal Service. The United States Attorney’s Office has not been served with a copy of the Complaint pursuant to Fed. R. CiV. P. Rule 4(1)(1)(A). A copy of the Complaint, including its attachments, is attached hereto as Exhibit A. This constitutes the only process or pleading which has been received to date. A Small Claims Court trial has been scheduled for January 30, 2018. 3. All pending coutt dates in Santa Clara County Superior Court should be automatically vacated upon the filing of this Notice of Removal. 4. Removal of this action to the United States District Court is made pursuant to 28 U.S.C. § 144] (a) and (6) because Plaintiffs seek monetary damages from the United States of America. It is removable to this Court pursuant to 28 U.S.C. §§ 1441(a) and 1442(a)(1) because it is a civil action against an agency ofthe United States. NOTICE OF REMOVAL USDC Case No. \OOO\IO\ 10‘ 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Case 5:18-cv-00099 Document 1 Filed 01/05/18 Page 3 of 4 5. A federal defendant removing under Section 1442 must demonstrate three things - that it is a “person” Within the meaning of the statute, that there is a “causal nexus” between its actions and plaintiff’s claim, and that it can assert a “colorable federal defense.” Durham v. Lockheed, 445 F.3d 1247, 1251 (9th Cir. 2006). Here, the Federal Defendant has met the three-part test for removal set forth in Durham. 6. A copy of this Notice of Removal of Civil Action is being filed with the Clerk of the Santa Clara County Superior Court, Small Claims Jurisdiction. This filing will automatically effect the removal action described above in its entirety to this Court for all future proceedings pursuant to 28 U.S.C. § 1446(d). 7. Pursuant to Civil L.R. 3-20), assignment to the San Jose Division is proper because the action was originally filed in Santa Clara County. Respectfully Submitted, BRIAN J. STRETCH United States Attorney Dated: January 5, 2018 By: /s/ Claire T. Cormier CLAIRE T. CORMIER Assistant United States Attorney Attorneys for Federal Defendant USPS NOTICE OF REMOVAL USDC Case No. \DOO\IC\ 10 11 12 13 14 15 16 17 1s 19 20 21 22 23 24 25 26 27 28 Case 5:18-cv-00099 Document 1 Filed 01/05I18 Page 4 of 4 CERTIFICATE OF SERVICE William Virav, et a]. v. United States Postal Services. et a]. Santa Clara Sup Ct/Small Claims # 17SC072064 USDC Case # The undersigned hereby certifies that she is an employee of the Office of the United States Attorney for the Northern District of California and is a person of such age and discretion to be competent to serve papers. The undersigned furlher certifies that she is causing a copy of the following: 1. Notice of Removal of Civil Action with Exhibit A and Civil Cover Sheet. to be served this date upon the party in this action by placing a true copy thereof in a sealed envelope, and served as follows: [X] FEDERAL EXPRESS via Priority Overnight [] EMAIL by mutual agreement of the parties to the party(ies) addressed as follows: Regresenting Pro Se Plaintiffs William & Representing Pro Se Plaintiffs William & Natividad Virax: Natividad Virax: William Viray, Pro Se Plf. Natividad Navarro Viray, Deceased Plf. 133 Vargas Court c/o William Viray, Pro Se Plf. Milpitas, CA 95035 45 Park Victoria # 118 PH: 408.834.3787 Milpitas, CA 95035 WViray@rnail.ccsf.edu PH: 408.834.3787 wviray@mail.ccsf. edu Representing Defendant Kaiser Permanente: Representing Defendant Steghen M. Raffle: Kaiser Permanente Stephen M. Raffle c/o Debra Contreras, Medical Legal Rep. 45 Wolfe Grade 770 East Calaveras Blvd. Kentfield, CA 94904 Milpitas, CA 95035 PH: 408.851.4167 Counsel for Defendant Stephen M. Raffle: Kevin P. Kelly, Esq, The Goldman Law Firm 55 Main Street Tiburon, CA 94920 PH: 415.435.5500/FX: 415.4355156 kkelly@goldmanlawfirm.net I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Executed on J anualy 5, 2018 at San Francisco, California. _/s/ Lily Ho- Vuong LILY HO-VUONG, Paralegal Specialist Assistant to Claire T. Connier, AUSA NOTICE OF REMOVAL USDC Case No. Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 1 of 12 EXHIBIT A Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 2 of 12 _\ Plaintiff's Claim and ORDER Clerk stamps date here when form is filed, \ SC-100 to Go to Small Claims Court _ _ Notice to the person being sued: ' You are the defendant ifyour name is listed in ® on page 2 of this form. The person suing you is the plaintiff, listed in CD 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. MD“ id fir hairc- ' Bring witnesses, receipts, and any evidence you need to prove your casc. Fm in mun name and street address: ' Read this form and all pages attached to understand the claim against you Superior Court of California, c°unty ”f and to protect your lights. Santa Clara Aviso al Demandado: git/13%;); (Emmi . , . a on ' Usted es el Demandado St 511 nombre figura en ® de la pagnna 2 de este 191 N First St formulario. La persona que lo demanda es el Demandante, la que figura en 3a” ndme, CA 951 13 (D de la paglna 2. Com fills In case number when form is filed. ' Usted y el Demandante tienen que presentarse en la corte en la fecha (161 Case Number: juicio indicada a continuacién. Si no se presenta, puede perder el case. 2” S g; f} T I? x“ it: {a . - J ‘ 7; ,r- ' Si pierde el caso la cone podria ordcnar que 1e quiten de su sucldo, dinero 11 Case Name: otros bienes para pager este reclamo. ' Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso ' ' Lea este fonnuleuio y todas las paginas adjuntas para entender la demanda en su contra y parga proteger sus derechos Order to Go to Court , 5' 1 'i V. The people in G) and (7) must go to court: (Clerkfills oulxection below.) Trial 63 Date Tige - Depargent Name and address of court, if different from above Date 1* 37048 30 4]" _ ape-nor COUPE $33" q rSt t. 3. 531111038, CA 95113 Datg: ’DEC a} 5 20m Clerk, by [PE/id Fifihfiim ’ Deputy Instructions for the person suing: - You are the plaintiff. The person you are suing is the defendant - Befo; e you fill out tins form read form 80 100- INFO Information for the Plaintiff to know you1 rights. Get SC- 100- INFO at any counhousc or county law library, or go to www.courts.ca.gov/smallclaims/fb17m - Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Makc one copy for each party named in this case and an extra copy for yourself.) Take or mail the original andrthesc cbpies 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 STE-104‘ SC 1048, and SC 104C. - Go to court on your trial date listed above. Bring witnesses, receipts and afly vidence you need to prove your case. /' , _ mama:Councilomanmrma www,courtsvca,gav Plaintiff's Claim and ORDER “-‘xsc-1oo, Page 1 of 5 Revlsad January I. 20 l7, Mdnflawty Fem) Cd KCMIP d , §116,1109t ,, 1:63:0(071133650é132 § seq to Go to Small Claims C041“: '9 (Small Claims) Case 5:18-cv-00099 Document 1-1 Filed 01/05l18 Page 3 of 12 Plaimiff (list names): _ William Viray Case Number: Pi! ® The plaintiff (the person, business, or public entity that is suing) is: Name: William Virav Street address: 133 vargas court Phone: 408-834-3787 Mailing address (ifdifferent): milpitas Ca‘ 95035 Street City State Zip Shaef City . State Zip If more than one plaintiff, list next p Name: Natividad Navarro Virav laintiff here: Phone: 408-834-3787 Street address: 133 Vargas court ' milpitas ca 95035 Street City State Zip Mailing address (ifdiflérent): 45 paIk Victoria #118 milpims ca 95035 Street City Siate Zip E] Check here if more than two plaintzflfs and altachfbrm SC-[00A. D Check here, g’feiiher plaintzfl‘Yisted above 1' D Check here [fany plal'ntlflis a “licensee” Code sections 23 000 et seq. 5 doing business under a fictitious name. Ifso, attach farm SC-103. or “deferred deposit originator " (payday lender) under Financial @ The defendant(the person, business, or public entity being sued) is: Name: United States Postal Service Street address: 80 lewis road Phone: 408-281-8506 Mailing address (fl‘dflferent).* milpitas ca 95111 Street City State Zip Street City Stale 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: Fin/WWW Job title, ifknown: 53km 3 ' (9'_ Addresszmriso mmdmg Mom“ 3AM (”A 1512-: Street City State Zip Check here zfyom' case is against more th an one defendant, and attach form SC-100A. D Check here ifcmy deféndanl is on active militwjy duty, and write his or her name here: @ The plaintiff claims the defendant owes $ m. (Explain below).- a. Why does the defendant owe the plaintiff money? Ike-defendmwhaplam ....- r . ,- , '1 ‘w w '\' W\m-}¢s +9 D\ When did this happen'. (Date): 08-18_2% b. If no specific date, give the time period: c. How did you calculate the money owed to you? (Do not include court costs or feesfor selvice.) ((4429: \-\ h (infirm-1Q 9 \\¥Q/‘ ’- Dale Started: Through: \ho mmb Lur+ CM‘ . [I] Check here zfyou need more space. Aflach one Sheet ql'paper orform M0031 and write "SCEILOQAItemj ” a! [he top. R“'““a““a’“‘ 2”” Plaintiff’s Claim and ORDER to Go to Small Claims Court 2, , a fitsgéwo, PageZofS (Small Claims) . i . _> Case 5:18-cv-00099 Document l-l Filed 01/05/18 Page 4 of 12 Plaintiff (list names): Case Number _, ( Mm Mn v' my 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? [X] Yes [I No If no, explain why not: C5) Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. (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. I). I: 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. Prom, § 395W) - c. [j I 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). (Cz'v Code, 3? 1812.10.) (1. [3 Where the buyer signed the contract, lives now, 01' lived when the contract was made, or where the vehicle is permanently garagcd, if this claim is about a vehicle finance sale. (Civ Code, § 2984. 4.) . [:1 Other (specify): (U List the zip code of the place checked in @ above (z‘fyou know): 95111 Is your claim about an attorney-client fee dispute? [I Yes [i No Ifyes, and g‘flvou have had arbitration, fill out fbrm SC-I 01, attach it to thisform, and check here: D _ _ WV. Are you suing a public entlty? Yes g; No Ifyes, you must/fie a written claim with the entity first. Q A claim was filed on (date): ‘ W l 5 / fig [? [ftlze public entiry denies your claim or does not answer within the time allowed by law, you can file misform. @ Have you filed more than 12 other small claims within the last 12 months in California? I] Yes IX] N0 [fyesg thefilingfiejbr this case will be higher, Is your claim for more than $2,500? Yes [:1 No [fyes, 1 have not filed, and understmzd that I cannatfile, more than two small claims casesfbr more than $2,500 in Calijbl'nia during this calendaryear. I understand that by filing a claim in small claims court, I have no right to appeal this claim. I declare, under penalty of perjury under California State law, that the information above and on any/attachments to this form is true and correct. ‘ i I! ‘ "@315: * Date: '12, {g}- g William Virav } “"5; V -, k , A Plaintlfllypes or prints name here Plain My“ here Date: wish/p MM rm U {RAM :5; (mm . ' x ' Second plaintifl types or rims name here Second plaintiff re Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, or Sign language interpreter services are available if you ask at least five days before the trial. Contact the clerk’s office for form MC-410, RequeslforAccommodations by Persons Wit/1 Disabilities and Response‘ (Civ. Code, § 54.8.) ““58““"a'y1'20‘7 Plaintiff’s Claim and ORDER to Go to Small Claims Court SIC-100v Page“f5 (Small Claims) -> Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 5 of 12 _ ' SC-‘I 00 Information for the defendant (the person being sued) "Small 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 mles are simple and informal. You are the defendant-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 cfairns case). How do I 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 TriaI” at www.courtsAca,gov/smallclaims/prepare. What ifl need an accommodation? If you have a disability or are hearing impaired, fill out form M0410, Request for Accommodations Give the form to your court clerk or the ADA] Access Coordinator. What if I 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 attorney to interpret for you or ask the court for a fist of interpreters for hire. Where can I get the court forms I need? Go to any courthouse or your county law library, or print forms at www. courts. ca.gov/sma/Iolaims/forms. What happens at the trial? The judge will lisken to both sides. Thejudge may make a decision at your trial or mai| the decision to you later. What if I lose the case? rfyou 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 80-140, Notice of Appeal. You must file within 30 days after the clerk hands or mails you the judge‘s decision (judgment) on form 80-200 or form 80-180, Notice of Entry of Judgment. . If you were not at the trial, fil| out and fife form 80-135. Notice of Molt'on 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 80-140. For more information on appeals, see wwwAcoudslcagov/ smallclaims/appeals. Do I 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 ClV-110, Request for Dismissal, with the clerk‘ Ask the Small Ciaims Adviser for help. - Prove this is the wrong court. Send a :etter 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, fit! out form SC-107 (Small 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 small 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 still file it in small claims court if you give up the amount overthe 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 auowed in smaII 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 ‘ransfer the plaintiffs '5 claim to that court to resolve both matters together. You can see a description of the amounts allowed in the paragraph above titled “Small Claims Court.” - Agree with the plaintiff's claim and pay the money. Or. if you can't pay (he 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 (defaufl), the judge may give the plaintiff what 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 I 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 pastpone 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 deiay 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 courk fees, unless a fee waiver was granted. Need help? Your county‘s Small Ciaims Advisor can help forfree. L, J Or go to www.courts.ca.gov/smallclaims/advisor‘ * Exceptions: Different limits apply in an action against a defendant who is a guarantor. (See Code Civ. Proc., § 116.220(c)‘) Ravlsed January 1, 2017 Plaintiff’s Claim and ORDER to Go to Small Claims Court (Small Claims) 80-100, Page 4 of 5a Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 6 of 12 I SC-‘l 00 lnformacién para el demandado (la persona demandada) La “Code de reclamos menores” es una corte especial donde se deciden 03505 per $10,000 o menos, Los individuos, 0 sea las “personas fisicas" y los propietarios por cuema propia, pueden reclamar hasta $10,000 Las corporaciones. asociaciones, entidades pL'Iblicas y otras empresas solo pueden reclamar hasta $5.000. (Vea abajo para las excepclones.‘) El proceso es rapido y barato, Las reglas son senclllas e informales. Usted es el Demandado-la persona que se esté demandando. La persona que lo esta? demandando es el Demandante. LNecesito un abogado? Puede hablar con un ahogado antes o después del caso. Pero no puede tener a un abugado que lo represente ante la corte (a menos que se irate de una apelacién de un caso de reclamos menores). (,Cc'mm me prepare para ir a la corte? No Iiené que presenter ningunos papeles antes del juicio, a menos que piense que ésta es la cone equivocada para su case. Pero lleve a! juicio cualquiertesfigos. recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su Juicio” en www.courts.ca.gov/reclamosmenoreslpreparese. LQué hago si necesito una adaptacién? Si tiene una discapacidad o tiene impedimentos de audicién, Hene elformulan‘o M0410, Request for Accomodations. Entregue el formulario al secretario de [a corte o a] Coordinador de Acceso/ADA de su corte. aQué pasa si no hablo bien Xnglés? Pregflntele al secretario de la corte lo mas pronto posible si en el juzgado habré un inlérprete disponible y cémo sollcitarloA No siempre estén disponib|es [as intérpretes de [a corte. Otra opcién es llevar a un adulto que pueda interpretar para usted slempre que esa persona no sea un lestigo ni un abogado. O puede pedir a la cone una lista de intérpretes particulares disponibles para contratar. éDénde puedo obtener los formularios de la corte que necesito? Vaya a cualquier edificlo de la corte, la biblioteca legal de su condado. o imprima los formularios en www.courts.ca.govl smallclaimslforms (pa’gina esté en inglés). LQué pasa en el juicio? El Juez escucharé a ambas partes Eljuez puede tomar su decision durante la audiencia o envlérsela por correo después ¢Qué pasa si pierdo el caso? Si pierde, puede apelar. Tendré que pagar una cuota. (El Demandante no puede apelar su propio reclamo.) . Si estuvo presents en el juicia, Ilene el formulario 80-140, Aviso de ape/acién (Nofice of Appeal). Tiene que presentarlo dentro de 30 dies después de que el secretario 1e entregue o envle Ia decisic’m (fallo) de! juez en el formulario {SC-200 o SC-130, Aviso d9 pub/icacién del fa/lo (Notice of Entry of Judgment). . Si no estuvo en el juicio, Ilene y presente el formulario SC-135. Aviso de patio/6n para anular e/ fella yDecIaracidn para pedirle al iuez que anule el fallo (decisién) Si la code no la otorga un nuevo luicio, tiene 1O dlas para apelar Ia decisién. Presente e1 formulario SC~140. Para obtener més informacién sobre Ias apelaciones, vea wwwv courts,ca.gov/reclamosmenores/apelaciones. aTengo otras opciones? Si. Si Io estén demandando, puede: . Resolver su caso antes del' Juicio Si usté‘d y [Demandante se ponen de acuerdo en como resolver _e| cash, el Demandahte tiene que presenter el formulario ON 1.10. Solicitud de desestlmaclén (Request for Dismissal) ante el secretario de a oorte. Pldale al Asesor de Reclamos Menores que lo ayudei}\ . Probar que es la coda equivocada. Envie una carta a la Corie antes del juicio explicando por qué cree que es la cone equivocada. Pidale a la corte que despida e] reclamo.TI'ene que entregar (dar) una copia de su carta (por correo 0 en persona) a todas las panes. (Su carla a la cone tiene que decir que hizo la enlrega.) . Ir al julclo y tratar de ganar el caso. Lleve testigos, recibos y cualquier prueba que necesite para probar su case. Si desea que la code emita una orden de comparecencia para que los testigos vayan al juicio, Ilene el formulario SIS-107, Citatorio de reclamos menores (Smafl Claims Subpoena) y entrégueselo legalmenke a! testigo. . Demandar a la persona que lo demandb. Si tlene un reclamo contra el Demandante, y el reclamo se puede presentar en la cone de reclamos menores, la| como se describe en este formulario, puede presenter el formulario SC-120, Reclamo del demandado (Defendant’s Claim) y prasentarlo en este mismo casoA Si su reclamo excede el Iimlte permitldo en la corte de reclamos menores. puede igualmeme presentario en la Corie de reclamos menores si esté dispuesto a Iimitar su reclamo al méximo permltido. o puede presenter un reclamo por el monto total en la cone apropiada. Si su reclamo excede e1 "mite permitido en la cone de reclamos menores y esté relacionado con el mismo contrato, vansaccién, asunto o acontecimiento que el reclamo del Demandante, puede presenter su reclamo en la code aproplada y presentar una moclén para transferir el reclamo def Demandante a cliche corte. para poder resolver los dos reciamos juntos. Puede ver una descripcién de los montos permitidos en e1 pérrafo anterior litulado “Cone de reclamos menores". . Aeptar el reclamo deI Demandante y pagar el dinero. O, si no puede pagar en esa memento, vaya al juicio y diga que quiere hacer los pagos. . No ir al julcio y aceptar el fallo por falta de comparacencla. Si no Ilega a un acuerdo con el Demandante y no va al Juicio (fallo por falta de comparecencia), el juez Ie puede otorgar al Demandante lo que esta reclamando ma’s I05 costos de la code. En ese caso, el Demandante Iegalmente puede tomar su dinero, su sueldo o sus bienes para cobrar el fallo, LQué hago si neceslto més tiempo? Puede cambiar la fecha del juicio si: . No puede ir a la corte en Ia fecha programada (tendré que pagar una cuota para aplazar e| juicio). o . No le entregaron los documentos legalmeme (no reclblé la orden para ir a la corte) por lo menus 15 dl'as antes del Juicio (6 20 dl'as s! vive fuera del condado), o - Necesita més liempo para consegulr intérprete. (Se permite un solo aplazamiento sin tener que pagar cuota para aplazar el juicio . Pregflnlgle at secretario de reclamos menores sabre las raglas y las cuo’tas para aplazar un juicio. 0 llene e! formulario SCI-150 (o escriba una carts) y envfelo antes del plazo a la carte y a todas las otras personas que flguran en sus papeles de la corte. Adjunte un cheque para pagar los costos de la corte, a menos que le hayan dado una exenolén. . LNecesita ayuda? El Asesor de Reclamos Menores de su condado {a puede ayudar sin cargo, J 0 visits www courts. ca. gov/mclamosmenores/asesores. ' Excapclones: Exislen difsremes “mites en un reclamo contra m garanla (Vea el Cédigo da Pmcadimianlo Clvll unclbn 116. 220 [c).) Revised January 1‘ 20‘}? _ Reclaqel Demandante y ORDEN 80100, Page 5 of 5 ‘ Para'lr a’la Corte de Reclamos Menores (Reclamos Menores) For your protection and privacy, please press the Clear This Form button after you have printed the form. IffPrli!“ ; I Save this form I Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 7 of 12 CaseNu her: (, fl .7 SC-100A Other Plaintiffs or Defendants L; 313 if; 0 a 3 r= a; 3:. This form is attached to form SC-lOO, item 1 or 2. (D If more than two plaintiffs (person, business, or entity suing), list their information below: Other plaintiff’s name: Street address: Phone: City: State: Zip: Mailing address (zfdifi’erent): City: State: Zip: Is this plaintiff doing business under afictz‘tious name? D Yes [:1 No If yes, attach form SC-103. Other plaintiff‘s name; Street address: Phone: City: State: Zip: Mailing address (zfdifferent): City: State: Zip: Is this plaintzfi‘doing business under afictitiaus name? D Yes [:I No If yes, attach form SC-103. E] Check here ifmore than 4 plainnjjfs' and fill out and attach another form SC-I 00A. @ If more than one defendant (person, business, or entity being sued), list their information below: Other defendant’s name: Kaiser Pennanente 5366‘ address: 770 east calaveras boulevard P110116: ([0? <5? 5 [~% I b? City: milpitas State: califomia Zip: 95035 Mailing address (if diflerent): City: State: Zip: If this defendant is a corporation, limited liability company, or public entity, list the person or agent authorized for service of process: Name: [70 kra 0,0 n+0; arm 3 Job title, if known: ,3 , i, z ‘ ,, ‘Y . Addre“: 1 'H) Eax$+ ofi‘qwms hon-Ltdwb‘ .- City: PM Ma my.» State: ck, Zip: 9; a 03;. Check here if your case is against more than two defendants, and fill out and attach another form SC-I 00A. (3) Is your claim for more than $2,500? Yes I] No If yes, I have not filed, and understand that] cannot file, more than two small claims cases for more than $2, 500 in California during this calendar year. I understand that by filing a claim in small claims court, I have no right to appeal this claim. I declare under penalty of perjury under California state law that the information above and on any attachments to this foxm is true and correct. Date: 1°. 131 23:} William eaV t Type or prmt your name 0‘ Date: HAS “'3- mum“ «(My «(52 r ("um/M \flflflfl flawed > Type 01' print youx name yUur name #:6212332:Pfizzflimsflxm Other Plaintiffs or Defendants 5°'1°°A’Page~°‘- °°‘°°'C‘V“P'°°°d"'e~ WG-"Wm (Attachment to Plaintiff's Claim and ORDER to Go to Small Claims Court) For your protection and privacy, please press the Clear Thls Form button after you have printed the form. Case 5:18-cv-00099 Document 1-1 Filed 01/05I18 Page 8 of 12 ' sc.100A Other Plaintiffs or Defendants “5"” fl P» 0) ® I declare under penalty of peljury under California state law that the information above 'fonn is 11116 and correct. Date: I2. [ 9| [1- 5: (’1: William Virav > E Type or mini your name Date: “Ask; \mhmumw (Mamm U1M7)Wuwx4 } This form is attached to foml SC-100,item l or 2. If more than two plaintiffs (person, business, or entity suing), list their information below: Other plaintiff‘s name: Street address: Phone: City: State: Zip: Mailing address (zfdiflerent): City: State: Zip: Is this plaintwr doing business under afictitious name? I] Yes [I No Ifyés, attach form SC-J 03. Other plaintiff 5 name: Street address: Phone: City: State: Zip: Mailing address (if diflerent): ’ City: State: Zip: Is this plainty’fdoing business under a fictitious name? [I Yes [I No If yes, attach form SC-1034 E] Check here if more than 4 plaintzfls‘ and fill out and attach another form SC-I 00A. If more than one defendant (person, business, or entity being sued), list their informatlon below: Other defendant’s name: Stephen Mcritt Raffle Sheet address: 45 wolfe grade Phone: City: kentficld State: califomia Zip: 94904 Mailing address (xfdzfi’erent): City: State: Zip: If this defendant is a camoration, limited liability company, or public entity, list the person or agent authorized for service of process; Name: Job title, if known: Address: City: State: Zip: [Z] Check here if your case is against more than two defendants, and fill out and attach another form SC-100A. Is your claim for more than $2,500? L75} Yes I] No .{f yes, I have not filed, and understand thatI cannot file, more than two small claims bases for more than $2,500 in California during this calendar year. l understand that by filing a claim in small claims court, I have no right to appeal this claim. Type or print your nailne #fifii‘ififififfiFf‘S‘i‘iifiémfiffifiifimv Other Plaintiffs or Defendants we °'°"" mad“ 5 “5'11" em“ (Attachment to Plaintiff‘s Claim and ORDER For your prmectian and privacy, please pres the Clear . ‘ This Form button after you have printed the form. IP31 to Go to Small Claims Court) l§ arm I Save this form-1 Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 9 of 12 MC-030 ATI'ORNEY OR PARTY WITHOUT ATTORNEY (Name. Slala Bar number. andaddress): FOR COURT USE ONLY William Viray 133 vargas court lllilpitas,califomia,95035 TELEPHONE NO.: 408-834-3787 FAX NO‘ (apnomn: E-MAIL ADDRESS (Optional): wviray@mail.ccsf. edu ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF santa Clara STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF/PETITIONER: William Viray DEFENDANT/RESPONDENT: USPS,Kaiser Permanente,and Stephen Raffle CASE NUMBER: DECLARATION - r. {E ‘; . ,3 . $L-lt'o lulu! E r ”J C5 O ' 2 ‘~..‘ *lf' 3,3 I am demanding for justice in the incident occured in August of 2009.] need my two properties that belongs to me.These are unconsented two documents that have scribble lineslt is not real signaturesl am demanding lost wagesl am demanding of the death of my grandmotherl am demanding of Violation rights and privacyThose defendants who violated my rights,they are referring to themselves.They might have shown of mild depressionAs far as I am concem,if they have severe mental problems,thc doctor is just in the phone call awayl am demanding that they should be in prison,lifetime.I am demanding to clear my medical record. \ Gamma gumbo F66 Wu xv he 0mm (1mm \oe-mwsec 9? MM 3mm WWW”? W‘Ufi swwn 3W" 3‘“? WW6 MM dQGQMc‘Sfi a.) H (5 Mimi/3 figmmxwx‘hfl 4%» W WMWW Wcmm WNW. ‘W" “V "W” SH” ”nwnR'Awr’" ckuoumnfl, {MN-«m km“ 3644‘" WA ““29”“ Mamfi RQQ‘C‘HL EMA Gr MAM» 'WMWA JAM Wt) W"! “M Diff/egs‘Mm 0&0nl mmwx. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct Date: \ . . . I'\ r\ W1 lham Vn'ay q (TYPE OR PRINT NAME) ( G IA'WRE 0F DECLARANT) E! Attorney for Plaintiff [3 Petitioner El Defendant 1:] Respondent I: Other (Specify): Form Approved fur Opllunel Use V DECLARATION Pas“ Of 1 Judicial Council of Caiifamwa mciuao [Rem January 1, 20061 Case 5:18-cv-00099 Document 1-1 Filed 01/05/18 Page 10 of 12 William Viray 133 vargas court Milpitas,Califomia,95035 408-834-3787 wvirafléamailficsf. edu Denial Lawsuit To whom it may concem: I notified the United States Postal Service, Kaiser Pennanente, and Stephen Raffle about the incident had occurred in the year 2009 which lead to severe bad reputation and they are referring to themselves about any mental problems that they accused about. I submitted several letters and put it in the certified letters just to make sure it is accepted and evidenced. Signature Plaintiff William Viray W . Qase 5:18lcv700099 Document 1-1 Filed 01/05/18 Page 11 of 12 51:92:10: Mutt of QLaItfurma ATTACHMENT 80-8006 <50a of fianta. Qflata Downtown Courthouse 191 North First Street San 1036’, California 95113 NOTICE TO SMALL CLAIMS LITIGANTS The Superior Court of California, County of Santa Clara - Smail Claims Division encourages alternative dispute resolution (mediation) to resolve cases where the parties agree to participate voluntarily. WHAT IS MEDIATION? Mediation is a voluntary process for resolving disputes with the help of a neutral third party, called a mediator. Mediation allows you and the other pariy to reach a mutually acceptable settlement of the cases instead of having to appear in court to have a judge impose a decision on you. Mediation proceedings are confidential and conducted in private, The mediator will not provide Iega[ advice, evaluate your case, or make any decision orjudgment for you. However, the mediator will help you and the other party focus on reaching an agreement that is acceptable to all parties involved in the dispute. The mediator will draft a written agreement. WHEN CAN I GO TO MEDIATION? You may participate in mediation before your court appearance date regardless of where the case was filed. If you choose mediation, you are encouraged to contact the following agencies as soon as possible to schedule the mediation or to ask any questions that you may have: SMALL CLAiMS DISPUTES SANTA CLARA COUNTY DISPUTE RESOLUTION PROGRAM SERVICES at (408) 792-2327 or email onencaseébohrsccaovnra or visit wvwvsccdrpsorq HOUSING & NEIGHBORHOOD DISPUTES SANTA CLARA COUNTY DISPUTE RESOLUTION PROGRAM SERVICES Community Disputes at (408) 792-2327 or email opencase@ohr.sccgov.org or visit www.scces.org 0R PROJECT SENTINEL Gilroy, Palo Alto, Mountain View, and Sunnyvale at (408) 720-9888 The staff at the offices listed above will discuss the mediation process with you. They can provide a wide variety of conflict resolution services. HOW DOES MEDIATION WORK? Both the plaintiff and the defendant must agree to participate in the process. A mediaLor from the program will meet with you and the other party in your case. You may wish to call the dispute resolution program office ahead of time to try to resolve your Small Claims case before the hearing date. If your case is resoived through mediation, you and the other party will Sign a kocument that outiines what you both have agreed to do. If you are not able to resolve your case through mediation: you will 90 IO com add a judicial Officer wili hear your Case. Mediation will not delay your opponunity for a court hearing. The Court, of course, hopes that the mediation will resolve the dispute and eliminate the need for court action. sc-seoa Revowoma NOTICE TO SMALL CLAIMS LITIGANTS Page"! 2‘2 Mflfimfia Glare: Downtown Superior Court 191 North FlrstSIreeI San Jose. Califomia 95-1 l3 RETURN SERVICE REQUESTED 1;: r .., ~ HEN WV fimfiufi: Cami nf (flafifumia ,‘E Lfiéfiéfijm ififli II lllll |l|||| NILE 1:371] DBUB DEE“ HEEL United States Postal Service Serve on: Erin Jones; Postmaster General 1750 Meridian Avenue San Jose. CA 95125 1780072064 1/30 flfi-‘nifiifiéfifiififiéiifii mam Jit’ll)!”1I’Wimwh'fl'fllnI’M!!!"'flli’hmimth 213 J0 81 3id 8T/SO/TO pal!:| I'T 1U3UJn300 66000‘A3'8T19 9393 JsicAND 44 (Rev. 06/17) Court to initiate the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM) Case 5:18-cv-00099Cfipfigrfigm gfififilltOS/m Page 1 of 3 The J S-CAND 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form, approved in its original form by the Judicial Conference of the United States in September 1974, is required for the Clerk of I. a PLAINTIFFS LIAM VIRAY, NATIVIDAD NAVARRO VIRAY, Plaintiffs. (b) County of Residence ofFirSL Listed Plaintiff Santa Clara County (EXCEPTIN as. PLAINTIFF CASES) (0) Attorneys (Film Name, Address, and Telephane Numbel) See Serv1cc Llst on Page 3 E A ‘1 IS [HRngT-ams POSTAL SERVICE, KAISER PERMANENTE, STEPHEN MERIT'I‘ RAFFLE Coun of Residence of First Listed Defendant (IN u. _ PLAINWFF CASES ONL Y) NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE TRACT OF LAND INVOLVED. Aflomeys (Imzwn) See Service List on Page 3 H. BASIS OF JURISDICTION (Place an “X" in One But Only) 111. CITIZENSHIP 0F PRINCIPAL PARTIES (Place an “X" in One Boxfar Pluimifl (For Diverxily Cusex Only) and One Bax/or Defendant) 1 us 0 Pl ‘ ‘fi 3 1~ d 1Q n' PTF DEF PW DEF . . 'ovemmem amt: 'c era ucs on - - - . . ‘ . (U. S Government Not a Party) Cmmn of 11115 brace l I lncorptlmtsd my Ppncxpal Place 4 4 ufBusmcss ln 11115 State X 2 U S G t D f d ‘ 4 D‘ 'ty Citizen of Another State :2 2 Incorporated and Principal Place 5 5 ‘ . ovemmen e en an wars: . 1 di 1 Chi h' P m i I III . ‘ ofBusmess In Another State W ()1 ca 2 zens 1p of a e: n rem ) senorSubject of a 3 3 Foreign Nation 6 6 Foreign County IV. NATURE OF SUIT (Place an “X" in One But Only) CONTRACT? ‘ , ‘ . - 1, _ TORTS éFORFEmTRE/PENALTY BANKRUPTCY ‘ ' {‘30'1'HI'cRJsTATUTE‘sw 1 ‘1 10 Insurance PERSONAL INJURY PERSONAL INJURY 625 Drug Related Seizure of 422 Appeal 28 USC § 158 375 False Claims Act ‘120 Marine 3310 Airplm 365 Personal Injuw_ Product “Over!!! 21 USC § 331 423 Withdrawal 28 USC ~ 376 Qui Tam (31 USC . 13° Millar A“ 515 Airplane Product Liability Liability 690 Other § 157 § 3729(8)) ,140 Negotiable Instrument ‘320 Assault, Libel & Slander 367 Health Care/ j LABOR mommy RIGHTS ; 400 State Reapportionment 150 R5°°V°TY 0‘ 330 Federal Em 10 613’ Phymaceunca] 2869“] 710 Fair Labor Standards Act 820 C0 ri hts “Q Animus: Overpayment of Liabflj p y IDJ‘W Product hab'l'ty py g 4310 Banks and Banking , W . 720 Labor/Management 830 Patent Veteran s Benefits . 368 Asbmos Personal Injury . \ ‘ 450 Gamma“,e 15] Medicare Act .340 Mm“ Product Liability Relatlons 835 Patent-Abbreviated New _ 345 Marine Product Liability PERSONAL PROPERTY 740 Railway Labor Act Drug Application ‘ 460 Deportatxon 152 Recovery ofDafaulted 350 Motor Vehicle . : 751 Family and Medical 840 Trademark ‘ 47° Racketeer Influemd 3‘ Student Loans (Excludes ‘ . :370 Other Fraud Corru t0 anizations Veterans) 355 Motor Vel-ucle Product , . , Leave A“ SOCIAL SECURITY 4 p rg . 153 Raceway of Liability 337‘ “um “‘ ”“d 790 Other Labor Litigation . \ ; 480 Consumer Credit X 360 Other Personal Injury 380 041'" Personal Property 791 Emplo ee Retirement 861 HIA(1395fl) ‘ 490 CablrJSat TV Overpayment D e Y ' 86 l , . . . ‘35; p 1111-“ ~Medical . amag Income Secunty Act , 2 3 301‘ Lung (923) ‘ 850 Secunues/Commoditias/ of Veteran s Bandits ersona J Y)’ 160 s khaki ’ s . Malpractice 385 mpg”! I.‘ Product MIGRATION 353 DIWC/DIWW (405(9) Exchange 190 om "8 ““s “mm” 62 . . \864 3311) Title XVI 890 Other Statutory Acfions “‘5‘ “m” CIVIL RIGHTS PRISONER PETITIONS 4 ”8“"3‘1‘2.““°“ ’865 RSI (405(3)) ‘ 891 Agricultural Acts 195 Contract ProductLiability , J ‘ . , APP‘WM“ ' 393 E ‘ .11 M 196 Franchise '‘440 0th? CIVII nhts HABEAS CORPUS 465 other Immigration FEDERAL TAX SUITS ‘ nvlronment atte‘rs \ :441 VO‘mE 463 Alien Detainee Actions 870 Taxes (U.S. Plaintiffor 895 F ”"107“ “f Information REAL FROPERTY :442 Employment 510 Motions to Vacate . Defendant) , Apt 4 . 210 Land Condemnation 443 Housing/ ' Senlence 871 "(3.111d Party 26 USC f 896 Arbitration 220 Foreclosure Accomodations 530 General §7509 ‘ 899 Admuuspatwe Procedure 230 Rent Lease & Ejectment 445 Amer. w/Disabfliu'es- 535 Death penany get/Rewew pr. Appaal of Employment gency Decmon ,240 Tons to Land Ul'HER 950 C ' ‘ ' . . . ‘44s Amer. w/Disabilidw-Other mammal"? 01‘5““ 245 Tort Product L1ab111ty . S40 Mandamus & Other Statutes '290 All Other Real Property 448 “mm“ 550 Civil Rights ‘ [555 Prison Condition 560 Civil Dctainer Conditions of Confinement V. ORIGIN (Place an ”X" in One [lax Only) 1 Original X 2 Removed from 3 Romandod from N 4 Reinstatod or S Transfexred from 6 Multidistrict 8 Multidistrict Proceeding State Court Appellale Cnun Reopened Another District (spec'yfil) LitigationiTransfer LifigaficnrDirecl File V]_ CAUSE OF Cite the Us. Civil Statute under which V911 are filing (Do not cite iurivdicfiunulstagqtq unless diversify): ACTION 28 USC § 1441(a), 1442(ax1), and1446 Brief descrintion of cause: _ This case should be removed to Federal Disfiict Court because it is a personal injury case against a federal agency for monetary damages. VII. REQUESTED IN , CHECK IF TEES IS A CLASS ACTION DEMAND S 10,000.00 ‘ CHECK YES only ifdemandcd in complaint: COMPLAINT: UNDER RULE 23, Fed. R. Civ‘ P‘ JURY DEMAND: Yes X No VHI. RELATED CASE(S), JUDGE DOCKET NUNDBER IF ANY (See instructions).- IX. DIVISIONAL ASSIGNMENT (Civil Local Rule 3-2) (Place an “X” in One Box Only) SAN FRANCISCO/OAKLAND X SAN JOSE EUREKA-MCKINLEYVILLE DATE 01/05/2018 SIGNATURE OF ATTORNEY OF RECORD /s/ Claire T. Cormier (Draft) JS-CAND 44 (rev. 07/16) Case 5:18-cv-00099 Document 1-2 Filed 01/05/18 Page 2 of 3 INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS-CAND 44 Authority For Civil Cover Sheet. The JS-CAND 44 civil cover sheet and the info1mation contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, except as provided by local rules of court. This form, approved in its original form by the Judicial Conference of the United States in September 1974, is required for the Clerk of Comito initiate the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney filing a case should complete the form as follows: I. a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title. b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides atthe time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location of the tract ofland involved.) c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this section "(see attachment)." II. Jurisdiction. The basis of jurisdiction is set forth under Federal Rule of Civil Procedure 8(a), which requires that jurisdictions be shown in pleadings. Place an "X" in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. (I) United States plaintiff. Jurisdiction based on 28 USC§§ 1345 and 1348. Suits by agencies and officers of the United States are included here. (2) United States defendant. When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box. (3) Federal question. This refers to suits under 28 USC § 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked. ( 4) Diversity of citizenship. This refers to suits under 28 USC § 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different paiiies must be checked. (See Section III below; NOTE: federal question actions take precedence over diversity cases.) III. Residence (citizenship) of Principal Parties. This section of the JS-CAND 44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cairnot be dete1mined, be sure the cause of action, in Section VI below, is sufficient to enable the deputy clerk or the statistical clerk(s) in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive. V. Origin. Place an "X" in one of the six boxes. (1) Original Proceedings. Cases originating in the United States district courts. (2) Removed from State Court. Proceedings initiated in state courts may be removed to the district courts under Title 28 USC§ 1441. When the petition for removal is granted, check this box. (3) Remanded from Appellate Court. Check this box for cases remanded to the district court for further action. Use the date ofremand as the filing date. ( 4) Reinstated or Reopened. Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. (5) Transferred from Another District. For cases transferred under Title 28 USC § 1404(a). Do not use this for within district transfers or multidistrict litigation transfers. (6) Multidistrict Litigation Transfer. Check this box when a multidistrict case is transferred into the district under authority of Title 28 USC § 1407. When this box is checked, do not check (5) above. (8) Multidistrict Litigation Direct File. Check this box when a multidistrict litigation case is filed in the same district as the Master MDL docket. Please note that there is no Origin Code 7. Origin Code 7 was used for historical records and is no longer relevant due to changes in statute. VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes unless diversity. Example: U.S. Civil Statute: 47 USC § 553. Brief Description: Unauthorized reception of cable service. VII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Federal Rule of Civil Procedure 23. Demand. In this space enter the actual dollar amount being demanded or indicate other demand, such as a preliminary injunction. Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded. VIII. Related Cases. This section of the JS-CAND 44 is used to identify related pending cases, if any. If there are related pending cases, insert the docket numbers and the corresponding judge names for such cases. IX. Divisional Assignment. If the Nature of Suit is under Property Rights or Prisoner Petitions or the matter is a Securities Class Action, leave this section blank. For all other cases, identify the divisional venue according to Civil Local Rule 3-2: "the county in which a substantial part of the events or omissions which give rise to the claim occurred or in which a substantial part of the property that is the subject of the action is situated." Date and Attorney Signature. Date and sign the civil cover sheet. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 28 Case 5:18-Cv-00099 Document 1-2 Filed 01/05/18 Page 3 of 3 SERVICE LIST Representing Pro Se Plaintiffs William & Natividad Virax: William Viray, Pro Se Plf. 133 Vargas Court Milpitas, CA 95035 PH: 408.834.3787 WViray@mail.ccsf.edu Representing Pro Se Plaintiffs William & Natividad Virax: Natividad Navarro Viray, Deceased Plf. c/o William Viray, Pro Se Plf. 45 Park Victoria # 1 I 8 Milpitas, CA 95035 PH: 408.834.3787 wviray@mail.ccsf.edu Representing Defendant Kaiser Permanente: Kaiser Permanente c/o Debra Contreras, Medical Legal Rep. 770 East Calaveras Blvd. Milpitas, CA 95035 PH: 408.851.4167 Representing Defendant Stephen M. Raffle: Stephen M. Raffle 45 Wolfe Grade Kentfield, CA 94904 Counsel for Defendant Stephen M. Raffle: Kevin P. Kelly, Esq. The Goldman Law Firm 55 Main Street Tiburon, CA 94920 PH: 415.435.5500/FX: 415.435.5156 kkelly@g0ldmanlawfirmnet Counsel for Federal Defendant United States Postal Service “USPS”: Claire T. Cormier, AUSA US. Attorney’s Office/Civil Division 150 Almaden Blvd., Suite 900 San Jose, CA 95113 PH: 408.535.5082/FX: 408.535.5081 Claire.cormier@usdoj. gov
