Request DismissalCal. Super. - 6th Dist.August 23, 2019X X /s/ A. Floresca /s/ A. Floresca Clerk of Court 10/21/2019 3:42 PM 10/21/2019 3:42 PM 10/21/2019 3:42 PM Electronically Filed by Superior Court of CA, County of Santa Clara, on 10/21/2019 3:42 PM Reviewed By: A. Floresca Case #19CV353651 Envelope: 3545955 19CV353651 Santa Clara - Civil A. Floresca CIV-1 10 PLAINTIFF/PETITIONER: AKRIVIS LAW GROUP, PLLC CASE NUMBER: DEFENDANT/RESPONDENT: SADR EMAD-VAEZ, et a1. 19-CV-35365 1 COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or more in value by way of settlement, compromise, arbitration award, mediation settlement, or other means, the court has a statutory lien on that recovery. The court may refuse to dismiss the case until the lien is satisfied. (Gov. Code, § 68837.) Declaration Concerning Waived Court Fees 1. The court waived court fees and costs in this action for (name): 2. The person named in item 1 is (check one below): a- E not recovering anything of value by this action. b. E recovering less than $10,000 in value by this action. c. E recovering $10,000 or more in value by this action. (Ifitem 20 is checked, item 3 must be completed.) 3.D All court fees and court costs thatwere waived in this action have been paid to the court (check one): E Yes :3 N0 l declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: b (TYPE 0R PRINT NAME 0FE ATTORNEYE PARTY MAKING DECLARATION) <5‘GNATURE7 CIV-110 [Rem January 1, 2013] REQUEST FOR DISMISSAL Page 2 of2 LexisNexis® Automated California Judicial Council Forms
