Plaintiff s Claim 1501 to 5000Cal. Super. - 6th Dist.March 12, 2020BY FAX Plaintiff's Claim and ORDER to Go to Small Clalms Court Notice to the person being sued: You axe the defendant ifyour name is listed in on page 2 ofthis form. The person suing you is the plaihtifi‘, lis'ted in on page 2. You and the plaintifi must go to court _on the tn'al date listed below Ifyou do not go to court, you may lose the case. 1f you lose the court can order that your wages, money; or property be taken to pay this claim. Bfing witnesses. receipts, and any evidence yon need to prove your case. Read this form and all pages attached to understand the clalm against you and to protect your rights. Clark stamps date hora whohHIJfifi Is" filo d. Fm In court name and 31m: address: ~ Superior Conn of California. County of Santa Clara Aviso al Demandado: ' Usted es el Demandado si su nombre figura en.®de la pégina 2 dc est: formular'ro La persona que lo demanda es e1 De'm'andame, la que figura en 191 North First Street San Jose. 951 1 3 Downtown Superior Court ®de la pégma 2i Cour!Ms In case number when form Is mam r ° Usted y el Dcmandante tienen qug prescntamc en la corte en la fecha del Cage Number: Julclo mdncadaa oonnnuaclon Smo se presenta, puedc pcrder cl caso. g {fl S (C; ® 8 2 Q © {)9 ' Si pierde e1 caso la corte podria ordenar quc le quiten de su sueldo. dinero u Q33? Name: otms bienes para pagar este reclamo HUMANGQOD NORCAL' etc, ' Lleve testigos, recibos y cualquier otm prueba quc neceéite para probar su V- W'RSCH case.» Lea estc formulario y todas las pégihas adj'unm para egtender la demands en su contra y para protege: sus derechos. Order to Go to Court The people in (D and ® must go t_o coUrt: (Clerkfills om section below.) Trial Ti DepanLriem Name and address ofcoun, ifdifi‘crcm from above I Date :SIUIQQ":00M I , .. _. , 3' $A Ix I axe: mg 142. 2320 Clemby >\ “$01\mewI u ‘ v \ Instructions for the person suing: . . Martinez ' You am the plaintifi' The person you are suing is the defendant - Bejbre you fill out this form read form SC-lOO-INFO, Injormationfor (he Plaintifl to knowyour rights. Get SC-100- INFO at any courthouse or county law liblary, or go to www. courts.ca.gov/smallclaimsfirms. o Fill out pages 2 and 3 ofthis form. Then make copies of all pages ofthis form. (Make one copy for each party namcd 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 of your tn'al in the box above. ~ You must have someone at least 18-not you or anyone else listed in this case-give each defendant a coun-stampcd copy of all five pages ofthis form and any pages this form tells you to attach. Thor: am special rules for “sewing,” or delivering, this form to public entities, associations, and some businesses. See forms SC-104, SC-IO4B, and SC-104C, Go to court on your trial date listed above. Bring witnesses. receipts, and any evidence you need to prove your case. WlComd dc.llunh.mmanna Rwuodhnwy 17 m0.mun Fom: Coc- acun Pneum- fi 113.110 oz uq. 1w mg), 1mm Plaintiffs Claim and ORDER to Go to Small Claims Court (small Claims) 80-100, Page 1 ofS WDMHMWK _> Plaintiff (list names).-HUMANGOOD NORCAL. a Caliiomla domestlc nonprofit Case Number: comorgtion. dolqg business as THE TERRACES AT LOS ALTOS 2 ® S a® 8 2 Q Q 0 (D Thecplauintiff gigs Igoemon, business, or ublic entity that Is suing) ls:UMANG RCAL a Camomla domeatl nonprofit corporation. I I Ills IERRECES “I I OS “IDS Phone: (650) 948-8291 StreetcaddICSS' 373 Pine Lane Los Attos CA 94022 Strut City State Zip Mailing address (lfdifl‘erent): Street City Slate Zip If more than one plalntlff, llst next plaintiff here: Name: . .; u . .,Phong_:'- Stmetaddmss: sum city smo 21p Mailing address (Iqufgwgent): Shoal City Stale Zip D Check here (fmore than two plaintifls' and allachjorm SC-JOOA E Check here ifeilher plaintifl listed above is doing business under afictmous name. ljso, attachform SC-l 03 D Check here (fany plaintiffs a “licensee" or "deferred deposit originalor''(payday lender) under Financial Code sections _2_300__0 e; seq. ® The defendant (the person, business, or public entity being sued) Is: Name mmmmn .. Phone Stmtaddress:ML mAnos CA m2 sane! city 5m. 73p Mailing address fifdfflerem); Street Oily State 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: Job title. if known: Addressé Street City State Zip D Check here ifyour case is against more than one defendant, and cmachform SC-IOOA. D Check here ifany dejéndam is on active mililmy duty, and write his or her name here: ® The plaintiff clalms the defendant owes S 2 551 . (Explain below): a. Why does the defendant owe the plaintiff money? Plaintiff a skilled nursing facility provided care and services to Defendant Carmela Wrsch Defendant fang to Dav for services provided to her. When did this happen? (Dare): b. [f no specific date, give the time period: Dyna started: Ma“ 25 2011 Through: “ma g 2012 c. How did you calculate the money owed to you? (Do n0! include court costs orfeesjbr service.) D Check here ifyou need more space. Allach one sheet ofpaper orformMC-031 andwme "SC-100 Ilem 3 " a! the top. “"“W‘ 2°” Plaintiff’s Claim and ORDER to Go to Small Claims Court 30'100- “9° “'5 (Small Claims) ' ‘9 //fi\ _ /’ 7 \‘ ,r’ ‘ ‘1 ‘ AK ,1 \\ Jx ,/ x Plaintffi' (list names):HUMANGOOD NORCAL. a Calilomia domestic nonprofit Case Number: Q oral'on. do‘ b i s as THE TERRACES AT LOS ALTOS (00m _' ,,.'"9 “5"95 ,. gflgcg 829%) ® You must as’Kthe defendant (In person, In writing, or by ph'dhé) t6 pay you befdifi'you sue. If your claim is for possesslon of property. you must ask the defendant to glvé you the property. Have you done this? m Yes D No If no, explain why not: © Why are you filing your claim at this courthouse? This courthouse cov_ers the area (check the a_n__e (th apphesj a. E (l) When the defendant lives or does business. ' (4) Where a contract (written or spoken) was made, (2) Where the plaintifi’s property was damaged. signed, performed, or broken by the defendant or (3) When the plgintifi was injumd. where the d_chndgnt lived or did business when the defendant made the contract. b. D Whom the buyer or lessee signed the contract, lives now, or'lived when the contact was made, ifthis claim, is about an ofi‘er or contract for personal, family, or household goods, services, or loans. (Code Civ. Proa. § 395M) c. D Whem the buyer Signed the conuact, lives now, or lived when the contract was made, if this claim is about a retail installment contract (like a credit card). (Civ Code, § 1812.10.) d. D Where the buyer signed the contragt, lives now. or lived when the contract was made, or where the vehicle is permanently ganged. if this claim 'is about a vehicle finance sale. (Giv Code, § 2984.4.) e. U_ Other (specbjl): V '. List the zip code of i'haybla‘bé" checked in @fiabove (Jfiu'ihbw): m2 ' 7 ® Is your claim about ah attomey-client fee dispute? D Yes ' B No lfyes. and ifyou have had arbitration, fill outfbrm SC-IOI, attach i! Io thisjbrm, and check here: D Are you suing a public entity? D Yes m No lfthe public entity denies your claim or does nor answer within the time allowed by law. you canflle lhlsfimn. ® Have you filed more than 12 other small claims within t_he last 12 months in California? D Yes m No Ifyes. thefilingfiefiar this case ml! be higher. 0 Is your claim for more than $2,500? D Yes B No Ifyes, I have nolflled, and understand (ha! I cannolfile. more than lwo small claims casesjbr more than 82.500 i'n California during this calendaryear. | understand that by flllng a clalm In small clalms court, l have no fight to appeal this claim. l declare, under penalty ofpetjury under California State law, that the information above and on any attachments to this form is {me and correct. . ‘ rWWDate: .v . W .. V . Q Wrm‘fl' ig hereDate: 9 Secondplainrifltypes or prints name here Secondplaimiflsigns here ; Requests for Accommodations ; Assistive listening systems, computer-assistcd rcal-timc captioning, or sign language interpreter ‘ services are available ifyou askht least five days before the trial. Contact the clerk’s office for form j MC-4 l0, Requeslfor Accommodations by Persons With Disabilities and Response. (Civ. Code. § 54.8.) Plaintiff’s Claim and ORDER to Go to Small Claims Co'urt 86-100. Page 3°15 (Small Claims) 9 $10.000 oi less are déclded. lndlviduals. lnciudng "natural peleona" and sole proprietors. may claim up to $10.000 are limited to cléima at $5 ooo. (See bezowtor exceptions. -) Tfie process ls quick and cheap. The rules are simple and informal You are the defendanl-the person being sued. The pamonwho is sulng you ls Ina plaintim'_ Do I head 'a lawyer? You may tafk to a lawyer balore or after lhe case. But you may not have a’ lawyer represent you In court (unless this Is an appeal from a small claims case). How do I get ready for court? You don't have to fiée any papers below your itial unless you think mls Is the wrong court for your me. But bring to your trial a'ny wflnmas. recelpm. and . evidence that suppérts you: case. And rbad'Be Prepared for Your Trial' at www. courts.ca gov/smallcla‘lms/pmp’are. What If I need an ’aocommodatlon? Ityou have a dsabimy or are healing Impaired, fill out form M0410, Request for Accommodations. lee the fovm to your court dérk or the ADA! Access Coordinator. What if I don't speak Engliéh well? Ask the court clerk as soon as possible tor a coun-proviqed lntetpreter. You may uge form lNT-300 or local court form lo i'equest an intéiproter. If a ' court Imarpteter'ta not available at the time of your tri’al. it may bé necegsary to reschedule your trial You cannot bring ypur own interpreter for lhe trial ’iinlasa thé Inierpreter has béen approved by the coun as a certified registered, oar ptovisionglly qualified interpyeter. (Se; Cpl. Rule‘a of Court, [92¢ >2.893,-'qnd [qrm INT-‘MO. ) Where can I get the court forms l need? Go to any courthouse or your county iaw ilbrary, or print forms al www mans ca gov/smellclgims/Iorms What happens at the trial? The judga win usten to both aides The judge may make a decision at your tria! or mall the decision to you istan- What If | lose the case?" you lose, you may appeai-.2You'|l have to pay a fee. (Plaintiffs cannot appeal their own claims.) . l1 you were at the trial. I’llo totm 80-140. Notice oprpeal. You must file within 30 days anal the clerk hands 9r musings you the Notice ofEmy of Judgment; . l1 you were not at the triaL fill out and filo iorm 80-135. Notice of. Motion to Vacale Judgment and Declaration, Io_ ‘ask the Judge :0 cancel the Judgment (decision), ll the Judge does not give you a new trial. you have 10 day's to appeal the decision. File form SC-140. For more Information on appeals. see www.cowfs.ce.gov/ smallclaims/appeals. Do I have options? Yes. It you are being sued. you can: ' Settle your case before the trial. lfyou and the pIalntifi agree on how to settle the case, the plalntm must file form ClV-‘l 10, Request for Dismissal, with Ihe clerk‘ Ask the Smaki Claims Adviser for help. ' Prove this ls the wrong court. Send 'a letter lo the court before your trial explaining why you think this‘Is the wrong court Ask the court to dismiss the dalm. You must ee_rvo (give) a copy o! your letter (by mall or In person) to all parties (Your latter to the court must say you have done so) - Go to the trlal and try to win your case. Bring MmmBa, receipts, and any evidence you need to provg your ease. To have the court orders witness to go to the tfiafifili o'ut form 80-107 (Small’CIaims swpoena) and have it served on lha witness - Sue the person who is s_u_lng you. It you have a claim againai the plaintiff, and the claim ls appropfiate for small dalms court as described on thia- form. you may me Defenda‘nr's Claim (form 80-120) and bring me claim In this action. If your claim ls fot more than allowed In emu" claims court you may still file It In small claims court ifyou give up lhe amount ovél the email claims value amount, or you may me a claim for the‘ fuil value of the claim m the 'apprcpria‘le court If your claim Is for more than allowed In small claims court andirelates to the same contract; claim, you may fiie your claim In the appropriana ooun and flie a motion to‘ transfer the plainmf's 's claim to that court to reséiye both matters together. You can sa'e 'a description of the‘ amounts allowed m the paragraph above titled "Small Clalm‘s Conn." - Agree with the plaintiff’s claim and pay the money. Or, it you can't pay the money now, go to your tlééi and say you want to make payments - Let the case "default." u you don't settle and do not go to the trial (default), the judge may give lhe' uninhff what he or she i'a asking tor plus court costs If this happens; the pla nh‘ff can 199811)! tnkg your money. wanes. and 9!st t9 92y thy judgment: What ifl nged more-tlme? You can change the trial date i1: You caring! go to court on the scheduled date (you will have to pay a fee 10 postpone the trlal), or You did not get served (receive this order to go to _court) a_t_ I_e___ast 15 days before the tda! (or' 2O days If you Hve outside the county), or You need more time to get an Interpreter. One postponement Is -al?owed and you will not have to pay a fee to delay the trial ' Ask the Small Claims Clerk abouk the rules and fees tor postponlng a Ma! Or fill out form SC-150 (or wake a lettet) and mai! it to the court end to all other people listed on your court papers before the deadline. Enclose a check for your court fees. unless a fee waiverwas granted. Nepq help? ‘ Your county's Small Claims Adviser can help for free. [_ Small=©iaims Adviser (408) 882=2100, (Options 2, 6) _J Or go to www.couns.caegov/smallclaima/advisor. " Exceptions: Different Hméta apuy in an action against a defendant who i5 a guarantor. (See Code Civ. Proc‘, § 118.220(c).) Raviudme 13020 Plaintiff’s Claim and ORDER to Go to Small Claims Court (Small Claims) 80-100. Page 4 o! 5 .9 /’\ fix // \‘ k g»x. SC-1 00 Informacién para e1 demandado (la persona demandada) La "Com dé metamos lilanorea". esum cone especial d_onde ea 'pemonas flfiu‘s‘ y Ids propiemrios gpr cuenh gfoglg, puaden mda'rfii?hfa"sahf$10.000. Las porpomcionea.-asodaclo‘nee; onfipados persona qua so om démandando. La' pgraona qua Io_ 05M demfindando ea e! Dorrisndahte - (,Ncco'mo un gbogado? Puéde h'a‘blar eon un abogado antaia' o g. despuds dol ea'so. Pero no puodo toner 'a un abogado quo to 'rspmaonb ante la com (a mono: qua a_e hate do una apelacibn do un ease da reclaims manoree) . gcémo me prepare pm lr'a la cone? No (ions qua presenm ningunoa papeles énm dal Juido. a mono: qua piens‘e qua 6m es Ia cone oquivooada para su cage. Para llayp a! julcb cualquier tesbgos; tacibos y ptupbaa qua npoyan su caao. Y Ion ?Esté preparado para su juicio' en www.eoum.ca.govkedamo'amenoreelpmparoog. gnué hago al necoslto una adaptaclbn? Si fiam una dmpacidad o fiena Impedimontoa do aufldbn, Ilene el formulario M041 0-. Raquqsuor Accomodations Entrogue o! formularia al ad’crqmrin d_e la aorta o al Coordinador do Aeoes'olADA do su cone. luué pan ‘sl no hablo blnn Ingléa? Solicits un ihflrpre’to al ummrip de Ia aorta lo més pninto posiblp. Puado unar el_ tormutario lNT-300 o un fonnulano da s'u com local. SI no em disponiblo un lmérpreta do la cone pew an luicio. 8's poaible qua a’e tenga que eambiar _la techs do nu juldo. No puedo [lover su propio interprets para el'pain a m'enoa quo‘ 9| intélprete hays aldo apmbado por la cone coma un inwrptete cotfifieado malatmdo. o provisionalmonte califiudo (Vea Ia rauIa 2 893 d_a In's Régi'as do la‘ Coné do California y al Jormulario lNT-1 40.) mbndo puedo obtaner lo: fgrmularios do la gem qua neqeslto? Vaya a cualquiot edifido do la_ com. la bibliowca legal do au condado. Probar qua es Ia oorte equivocada. Envlo una parts a la cone antes dot.jujcio explieendo por qua ores qua es la com qqulvoqg’da Pldnle a Ia com" que‘ doapldg' ol redamq Ugggqha: anhgar (day) una copia do su cam (pqrcom o on poisons) a: todaa la: parka (Su certs a la oort'o fiche qua décir qua hizo Ia anwaga. ) Ir al Julclo y hham de ganar el caao. Llove toshgoe. midboa y cuaéquiet pmsba qua necesib para probar Bu oéao. SI dean qua; la corte 0min una orden do companioendo pom qu‘a lo'a tasfigos v__ayan a} pioio. Henna! formularlo SC-1 07. Cllqtorlo _d_o mciqmos mango Demandar a Ia persona qua lo demandé. Si Iiona un roclamo contra ol Damandanta y _el reclamo gs puodo presentar oi'i Ia aorta do wdamoa momma. tel oomo so describe on est: formdan‘o. puedo preunhr el fonnulalio sc-120 Réclemo del demandado (Defendant‘s Claim) y presentarto on es‘h mlsi'no ééso SI sh radamo exude el "mile pétrnitidq on la aorta do reclamoa m‘enorog, puoda igmlmenha pmaenhrlp 6n In‘ aorta de raclamos menores d em dispuosto a Iimlhr su melamo II méxlmo permifido. n puedp pmsenhr un mctamo per ol manta tom! an Ia com apmpieda. SI s_u rodamo oxoede el limits permifido en la_ éorhé dé ro‘clamos menoron y ésfi rez'aciohado con ol mlano comma tansacoién asumn o acontsdmla'nb qua el redamo dol Domundpnb puoda pmsanhr éifiédam 0H linemo‘rjo apmplada y prmntar una modbn para hnafoiir e! redamo dal Domandante a dieha‘ cone. para poder resolver lo‘e dés' rocka'mos 'junhou. Puodo var una dascflpdbn da lou moms pennitidos en of pénafo antonw titulado 'Cono da réczamoa rnenoros'. Aepur cl roclamp del Demandanto y p_aga_r _el 11mm. 0- 3i no haoor be pages No Ir al ju Iolo y scepter oil fallo por falm do oomphre‘concla. Si o lmprima- los fonnularios an www.chum.ca' gov] smwdei'mslforms (pagina esfi on lnglés). Lcué pan an el Julclo? Eljuez aacudiarfl a‘ amban panes. El Juez pueda bmar au deduct: dumnto la-audiencia o enviéraela por coma mun? pin II phrdo al case? Si pierde. puedo apelar. Tendra qua pager una cuotn; (El Domindanm no puede' apolar nu pmpio redamo ) Si estuvo presents en 9| juicio, Ilene e! formulario SC-140 Aviso d9 apelacidn (Notice of Appaal). Tiene qua prasentarlo dontro d9 30 dlaa despuéa do qua el secremflo:£0 ontoguo o onvle la dodaién (fella) dal Juez en e! formulario 86-200 o 50-130. Amy do pubficacwn dal fallo (Notiéo of Entry oi Judgment) Si no estuvo en el-Mela, Ilene y presents el formularia sc-135. Aviso do pefio‘p‘Qn para anular a! fella y Dodana‘én para padirle al juez quo anulo 9| fallo (decision) Si la com no Io otorga un nuevn julcio. fiana 1O dias para apelar la decision Presents 0| formulario SC-1 40. Para obtanor mas informaoibn sabre laa apelaa‘onea, vea www. couns.co.gov/rademosmonomyapelga'onos. Henge otras opclonas? Si. Si lo aatfin demandando. puede: . Resolver su case antes del julclo. Si usmd y al Damnndante Ba ponen dc ncuerdo on came resolve: el case. ol Demandanta fiena qua presenter el forrnularb ClV-1 1 O. Solicitud do deaastimadbn (Request for Dismissal) gnte el aecrahn'o da la carts. Pldalo a! Aassor do Rednmoa Menores que lo ayude. no uega a un aouordo eon o'l Déimndanté y no va_ al juicio (fallo por fall's d9 oompareoenda). ol juoz In pueda otorgat al Domandanb Io qua em reclamando man Ina oostoa de Ia com, En sea ease. al Demandante legalmente puado tomar su dnoro'; eu sueldo o sus bianes para cobm el tallo (,Oué hngo s! necaxlm més flampo? Puada eambjar Ia fecha do! juiu‘o Bl. - No puede Ir a Ia com en la techs programada (tandré quo-pagat una ouch para apllazar e! juldo), a 0 No Ia bnu'agaron Ioa documents: legaimante (no reciblb Ia ordén para ir a la cone) por Io menoa 15 dlas' anus del juldo (6 20 dial 5i viva fuera del oondado). o 0 Necaskta MB flempo para consagulr lnwrprete. (Se permits un solo aplazamianm a_ln tenor q‘uo pager web para apiagar el uicio). Projgunble a§ secretarlo d3 redamoa menoreu ochre lac raglan y Ins cuoiaa pam aplazar un juldo. O Ilene ol lormulano SC~150 (o eocriba una earta) y anvlalo anba del plaza a Ia cone y a mdas Ia: otma personaa qua figumn en nus papoles de la cone. Adjunta un cheque pate pagarlos castes do la com a‘ moms qua lo hnyan dado um oxoncién. gNecuslta ayuda? El Asesor da Redamos Monoves de w condado lo puade ayudav sin eergo. Small Claims Adviser (408) 882-2100, (Options 2, 6) O vialm www.nouns.m.gov/nclammanoms/asasorea. ' Exclpdonn:amMum Hm: en unmmum gaunt. [Vol d 06690 dc Prwodlnimto Chrl ucddn 111m (:).)W Jammy 1.m RecIamo del Demandante y ORDEN 86-1 00, Page 5 of 5 Para Ir a la Code de Reclamos Menores (Reclamos Menoras) 5003 Fictitious Business Name €22 {flag {WE} 8 2 Q (Q Q This fomis attachedto: D Form SC-lOO 0R (C1 Form SC-JZO ® Ii you want to flle a small clalm and you are doing business under a tlctlllous name (“dolng buslness 88," OI' "db__8") give the followlng Information. (Nonprofit; and exempt real enate investmen! trusts do rm! have t0 le this 0mg ANGO D N RCAL. a California domestic nonprofit corporation. doing bualness as Busincss name of t_hc person suing: THE TERRACES AT Los ALTOS Busingss address (nor a U.S. Postal Service P.0. Box): 323 Bing Lang. Les Aim. QA 25922 Mailing address (ifdtjfi‘erenr): ® The ggslness Ilsteq In® dwggs buslness as (check ONLY one);- D anindividual m acorporation D an association alimitcdliability company D apartnership E] ottwr(.:9pecifi) You mustfollow the lawsforflclitious business names. lfyou have notfallowed these laws. mcludmgfihng a fictitious business name statement in your county and publishing this infoman‘nn'm a local newspaper, the court can digmm your case. ® Name of county where you filed your Fictltlous Business Name Statement (dba): SamaQaLa County ® Your Flctltlous Business Name Statement numberz-Egge42151 Date your Flctltlous Business Name Statement explres:_Mgv 1o 2091 l declare. under penalty of perjury under California State law. that the information above is true and‘ 99mm. """ Only the owner, president, chief executive officer (CEO), or other qualified officer can sign this form. Date: 3LLQJZDZQ____ 2.x 1' (. Ambfiy Type o your name and u't e Sign®wmw elp? ®Your county' s Small Claims Adviser can help for free.[mmmmmmm-wq (408) 882-2100, (Options 2, 6) I I 0r go to “County-Spccific Court lnfonnation" at: www.courtinfo.ca.gov/selfllelp/Jmallclaims MN“W“‘wmNWEW Fictitious Business Name 50403. P8091 0”R . . 'fifiaméffimfii‘” (Small Claims) WMMW Bmman am Prawns Code. 5 W900 u no
