Defendant s Claim 5001 to 10000Cal. Super. - 6th Dist.February 27, 20203/ .r" sc_1 20 Dafendafit’s Claim aHd ORDER Clemstamps date here when fonnfsflled. to Go to Small Claims Court r ._ s. ‘ : " . u. .' .. "1 I ' 1 -: .5- “a .1 Notice to the person being sued: - You are being sued by the person you are suing. ,- - You must g0 to court on the trial date listed below. Ifyou do not go to court, NOV 1 0 2020 £55? you may lose the case. i . Ifyou lose, the court can order that your wages, money, 0r property be v. a fifg‘dfinmflfifig Clam taken to pay this claim. 3y 25 _- ~ . . DEPUTY - Bring witnesses, receipts, and any evidence you need to prove your case. Fifi in court namyand street address: - Read this form and all pages attached, to understand the claim against _ _ , Superior Court of California, County of you and to protect your rights. Aviso al demandado: Downtown Superior Courthouse S || laim ' La persona que ha demandado lo esté demandando a usted. 131:8“! CFirSt Sgt - Tiene que presentarse a Ia corte en 1a fecha de sujuicio indicada a San José' CA 951 1 3 continuacién. Si no se presenta, puede perder el caso. Fifi in case number and case name: Case Number: - Si pierde el caso la corte puede ordenar que le quiten de su sueldo, dinero u -‘ otros bienes para pagar este reclamo. - I v i recibos ' a e nece ite ara robarL e c test gos, y cualquler otra prueb qu s p p Case Name: sucaso. 20360827b§ - Lea este formulario y todas Ias péginas adjuntas, para entender Ia demanda en su contra y para proteger sps derechos. Order'to Go f0 Court The people in © and© must go to court: (Clerkfifls out section beIow.) Trial -) Date Time - Department Name and address 0f court if different from above Date 1. H 2. 01/13/21 8:36 am 15 9% 3. . n Date: NOV l a 2020 Clerk, by EPR H“; 1/ ‘r a DePUty Instructions for the person suing: ' Before ypu fill out this form, read Form SC-l OO-INFO, Informationfor the Plaintz’fi‘, to know your rights. Get SC-lOO-INFO at any courthouse 0r county law library, or go to: www.courtz'nfo.ca.gow_’forms - Fill out pages 2 and 3 ofthis form. Then make copies of all pages ofthis form. (Make 1 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 ofyour trial in the box above. - You must have someone at least 18-not you or anyone else listed in this case-give each Plaintiff a court~stamped copy 0f all 3 pages of this form and any pages this form tells you to attach. There are special rules for “serving,” 0r delivering, this form to public entities, associations, and some businesses. See Forms SC-104, SC-104B, and SC-l 04C. - Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case". audisiigounwogczagfimg.“moogns-ca-aov Defendant’s Claim and ORDER to Go to 80-120. Page-1 of3 ems anua , , anaryorm m 'm a Code of Civil Pgmdure. § 115.110 e1 seq. S ?gmcalnaICIaismcs? urt Case Number: 3.0 560827®5 Defendant (list names): ® The Plaintiff (the person, business, or public entity that sued first) is: Name: § E g E (2 lb mm Phone: (lo! 2323 X72 7 Street addms: ‘ 19“ Q {fie (gaging ‘12- fiat! 5 QQ gin alum (fa. Q S 652 1 StaleStreet City Zip Mailing address (ifdz'fl'erent): sane: cny Stare 21p If more than one Plaintiff, list next Plaintiff here: Name: , Phone: ( ) Street address: / Street any snare Zip Mailing address (ifdifi'trent): ' sneer City Stare Zip U Check here ffmore than 2 Plaintifis and attach Form SC-IZOA. U Check here ifany Plaintg‘fi'tls an active mih'taty duty and write his or her name here: ® The Defendant (the person, business, or public entity suing now) is: Name: Mngmjl/x Madaml Phone:mq Street address: lgqolq %.h‘ Mam QA @m (h . 9 SO ZZ) sweet cny State zrp Mailing address (ifdifierent): Street City State Zip If more than one Defendant, list next Defendant here: Name: , Phone: ( ) Streelt address: / Street City State Zip Mailing address (ifdifl'erent): Street City State Zip U Check here ifmore than 2 Defendants and attach Form sc-120A. U Check here ifeither Defendant listed above is doing business under afictitiaus name. Ifso. attach Form SC-I 03. _ ® The Defendant claims the Plaintiff owes $ [Q am 0'0 M‘meplain below): a. Why does the Plaintiffowe the Defendantmoney?flMd “‘fhr‘” 4/1.- ‘ ‘41 .Anna I -5‘AIA IA JxAV‘hlb%u a ,. ' __' ~ - ' ’ A b. When did this happen? (Date): Q g 2 2 fl z Q [q Ifno specific date, give the time period: Date started:_- Through: c. How did you calculate the money owed to you? o not include court costs orfeesfbr service.) 4 mom‘Hflg n-f rpn+ 4 X .. II 0g: $ IZ, ‘40)?) + dkey Cos-l-é‘ U Check here {fyou need more space. Attach one sheet ofpaper or Form MC-031 arid write “SC-120. Item 3 " “”"e “’P' noJr tt‘mHeA ‘36 +M- loss o-F ren+¢l incame and afim- ExPe/Inses “VB re. mediacpe HM {55%. mmmwtm Defendant's Claim a_nd ORDER to Go to 56-120. Page 2 of3 Small Claims Court '9 (Small Claims) Defendant (list names): Case Number: ® You may ask the Plaintiff (in person. in writing, or by phone) to pay you before you sue. Have you done this? D Yes M No ® ls your claim about an attorney-client fee dispute? D Yes R No Ifyes, and ifyou have had arbitration, fill out Form SC-l 01, attach it to thisform, and check here: U ® Are you suing a public entity? D Yes M No Ifyes, you mustfile a written claim with the public entityfirst. D A claim was filed on (date): [fthe public entity deniesyour claim or does not answer within the time allowed by law, you canfile thisform. Have you filed more than 12 other small claims within the last 12 months in California? DI; Yes M No Ifyes, thefilingfeefor this case will be higher. I I understand that by filing a claim in small claims court, I have no right to appeal this claim. If I do not have enough money to pay for filing fees or service, I can ask the court to waive those fees. I have not filed, and understand that I cannot file, more than two small claims cases for more than $2,500 in California during this calendar year. I declare, under penalty of peljury under California State law, that the information above and on any attachments to this form is true and correct. Daiezmmo Mahran Madam l. Defendant types orprints name here DefwfiW Date: _-|. 'q.‘x D SecondDefendant types orprints name here Second Defendant signs here Requests for Accommodations bb‘ gr: {é Assistive listening systems, computer-assisted, real-time captioning, or sign language interpreteré}; services are available ifyou ask at least five days before the trial. Contact the clerk's office or go to g?fig www.courtinfo.ca.gov/forms for RequestforAccommodations by Persons With Disabilities and Revised Jammy 1. 2011 Response (form MC-410). (Civil Code, § 54.8.) Need help? Your county’s Small Claims Adviser can help for free. [(408) 882-2100 option 2, then 6 between 2:30 p.m. and 5:00 p.m. Or go to “County-Specific Court Information” a1: www.courtirgfo.cagov/selfhelp/smallclaims Defendant's Claim and ORDER to Go to Small Claims Court (Small Claims) 90420. mama
