Request DismissalCal. Super. - 6th Dist.November 23, 2020Electronically Filed by Superior Court of CA, County of Santa Clara, on 12/1/2021 2:21 PM Reviewed By: M. Sorum Case #20CV373912 Envelope: 7767564 20CV373912 Santa Clara - Civil M. Sorum 12/1/2021 2:21 PM 12/1/2021 2:21 PM X 12/1/2021 2:21 PM M. Sorum X ClV-11O PLAINTIFF/PETJTIONER: American Express National Bank CASE NUMBER: DEFENDANT/RESPONDENT: Gary B Zoellner MD, et a1. 20CV373912 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, § 68637,) 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- D not recovering anything of value by this action. b4 D recovering less than $10000 in value by this action. C. D recovering $10,000 or more in value by this action. (lfr’rem 2c is checked, item 3 must be completed.) 3. [j All court fees and court costs that were waived in this action have been paid to the coun (check one): E Yes a NO I declare ugderienalty of perjury under the laws ofthe State 0f Caiifomia that the information above is true and correct. Date: Z 2021 l//l/x Spencer Penuela, Esq. SBN: (324544) ’ ' (TYPE 0R PRWT NAME 0F ATTORNEYD PARTY MAKING DECLARATION) (S’GNATURE) CIV»1 10 {Rev January 1, 2013} REQUEST FOR DISMlSSAL Page 2 ofz LavisxV‘L’xIS‘RW A Izammuied (Vufgfomm Jzuz’lctuf ("ozmcn’ Forms
