Plaintiff s Claim 1501 to 5000Cal. Super. - 6th Dist.March 12, 20203*! FAX ‘ Plaintiff's ngim a_nd ORDER ' SC'1 00 ‘ to Go to Small Claims Court Natico tol'bé'I‘ii’é’rQon being sued ‘ You am the defendant ifyour name is listed m Oion page 2 ofthis form. 1116 person suing you is the plaintiff. listed m 0 'on page 2; ' You and the plaintiff must go to court on the trial date listed below. Ifyou do not go to court, you Iggy lgsc the case. - 1f you lose, the court can order that your wages, money; or propeny be taken to pay this claim. E' mamnez ' Bring witnesses. receipts, and any evidence you need to prove your casc.- pm" com "am, .ndmuwdms; ' Read this form and all pages attached to understand the cléim against you suw'm cw" °' ca'mm'g' °°umy °f and to protect your right; Santa Clarfa Avlso al Demandado: 191 North Firs! Street ' Usted es e] Demandado si su nombre figum en® de la pégina 2 de este San Jose. 951 13 formulaic. La persona que lo demands es e] Demandamc, la que flgum en Downtown Superior Court (D dc la Pégi-"a 2 Cour: tugs tnam ngmborwhan mm Is mad, ' Usted y el Demandante tienen que pmsentaxse e_n la corte en la fecha del , Cain Numb": juicio indicada a communion;--Si no se presenta, puedc perder cl case.- 2 $3 G® 8 2 9 ® 1 ' Si pierde e! caso la oortc podria ordenar que le quiten de su sueldo, dinero u Gang Name“: otros biencs pam pagar esté reclamo. HUMANGOOD NORCAL, etc‘ ' Lleve testigos, recibos y cualquier otra pmcba que neceéite para probar su V: F'MMEL case. ' Lea cste formulario y todas las pfiginas adjuntas para. entender la demanda en su contra y para protegcr s’us derechos Order to Go lo Court Tho people in (D and® must go to court: (Clerkfills out section below.) Trlal -) Dar l Tire ' Dep em Name and address of court, ifdifi‘emnt from above ’ ‘ A2. Dale: MAR1m Clerk,by? mWWW Instructions. for the person 'sulng: E. “darting - You am the plaintifi. The person you are suing is the defendant. - Before you fill out this foxm, read fonn SC-lOO-INFO, Informationfor the Plainnfl, to know your rights. Get SC-lOO- INFO at any courthouse or county law library, or go to www.courts,cagev/smallclaimsf orms. o Fill out pages 2 and 3 ofthis form. Then make copies ofall pages ofthis form (Make one copy for each party named in this case and a_n extra copy for voutself.) Take or mail the original and these copies to the court clerk s omcc and pay the filing fee. The clerk “ill “- nte the date ofyour tn'al m the hex above - You must have someone at least 18mm: you or anyone else listed m this casewgive cach defendant a court-stampcd copy of all five pages ofthis form and any pages this form tells you to attach. There are special mles for “serving," or delivering, this form to public entities, associations, and some businesses. Sec forms SC-l 04, SC-IMB, and SC- 1 04C. - Go lo court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. mmflcgmmmuw Plaintiff‘s Claim and ORDER 30-100. P896 1 0'5 sgggmggg-unanmm to Go to Smau Claims Court WMMWW -> (Small Claims) Plaintifi (list names) HUMANGOOD NORCAL. a Caflfomla domestic nonprofil Case Number: corporation. doing b__usingss as THE TERRACES AT L__QS A_LTOS ............. 2®Sfi®829 @ 1 ®NTheeplaintiNeglae leoeRrggLn. gunsgn'esdsmort cpubllcmentlty fhat is suing) ls:a 00 0m Iona m a O BS! nonpro m Phone 650 948-8291 Street address: 373 Pine Lane Los Amos 9A 94022 _ strut glly Stat; 21p Mailing addrcss (Udtflerent): If more than one plaintiff, list next plaintiff here: Name; Phone: Stmet addmsy- ' sane: cny scare 21p Mailing address (1} diflerem): smut '” city 7' Stare 21p D Check here ifmare Ihan two plainlwls and attachform 30100.4.- E Check here tfeither plainfifllisted above is doing business under afictin'ous name. lfso, auachform SC-103. E] Check here Ifany plaintifl ts a ”licensee" or "deferred deposit orlginalor' (payday lender) under Financial ® The defendant (the person, business, or publlc entity being sued) ls: Name: Edamaudflmmal Phone. Sueetaddress j1 _: x u _ Los Alto; Hing 0A 94024 Sue's: (:Iiy 5m. 21p Mailing address (fdfl’erem) A Shae! City SM; 21p If the defendant isa corporation, llmlted liability company, or public entity, list the perSon or agent authorized for Service of process here: Name: Job title, ifknown: Add ress: Shae! City Sim Zip D Check here (fyour case is agaIm‘I more than one defendant, and attachform SC-IOOA. D Check here ifany defendant is on active military duly, and write his or her name here: @ The plalntlff clalms the defendant owes $ J 532 . (Explain below).- a Why does the defendant owe the plaintiffmoney? Plaintiff, a skmed nursingiacility. provided care and services to Defendant Edellraud Flmmel Dgfgnggnj fgilgggo fly er gwiggg gravided to her. When did this happen? (Date): b. Ifno specific dam give the time period: Date started: Match a 2mg Through:Mamh n 2mg c How did you calculate the money owed to you? (Do no! include court costs orfeesfor service.) H D Check here Ifyou need more space. Attach one sheet ofpaper arform MC-OJI and write "SC-100, Item 3 " a! the lop. “m“‘w’tm Plainfifl’s Claim and ORDER to Go to Small Claims Court sc'mo- 939° “‘5 (small Claims) '9 Plaintifi‘ (list names). HUMANGOOD NORCAL. a California domestic nonprofit Case Number: ootpomuqn, d_olng business as THE TERRACES AT LOS ALTOS wg g (D 8 2 9 ® JLv You must ask the défendant (In person, In writlng, or by phone) to pay you before you ' ‘ sue. If youn' claim ls for possession of property, you must ask the defendant to give you the property. Have you done thls‘? m Yes I. No lf no, explain why not: C6) Why are you flllng your clalm at this courthouse? This courthouse covers t_he area: (check the one that applies}- a. m ( l) Where 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) Where the pigintiffwas injurgd. whcrc the defendant lived or did business when the defendant made the contract. b, D Where the buyer or lessee signed the contract, lives now, or lived when the contract was made, ifthis claim,u ‘is about an ofi'cr or contraqt for personal, family, or houschqld goods, services, or lpans,x(Code Cw. Proci, , § 395(5)) c D Where the buyer signed the conttact, lives now, or lived when the contract wn made, if this claxm':s about a ' ' retail installment contract (like a credit card), _(Civ Code, § I812. 10.) d D Where ihc buyer signed the contmct lives now, or lived when the contract was made, or where the vehicle 1s pennancmly ganged, ifthis claim Is about a vehicle finance sale (Civ Code. § 2984.4 ) e. D Other (specify): 0Qua the zip coda of the mace checked in© above (rfyou know).- 94022 ® ls your claim about an attomey-client fee dispute? D Yes a No Ifyes, and (fyou have had arbimalion fill ouljbrm SC-I 01. attach i! Io thisform and check here: m Are you suing a public entity? C] Yes m No [fye3, you muslflle a wrmgn claim with (he emiqfirs; D A claim was filed on (da_te): lflhe public entity deniesyour claim or does no! answer within the time allowed by law. you canfile thasform. 0 Have you:filed more than 12 other small claims within the last 12 months in California? D Yes E No lfyes. Ihefilingfeefar this case will be higher. Q I'sV your claim for more than $2,500? D Yes B No lfyes, I have notfiled. and understand that I cannotflle, more than Iwo small claims casesjbr more than $2,500 in California during this calendar year. l understand that by filing a claim in small clalms court, I have no right to appeal this clalm. l declam, under penalty of perjury under Califomig State law, that the information above and on any mtachments to this form is tmc and comet. V Vmm Im 3x33%; vgmz5M Egg“ 3b: >WhoFlam! pes or prints na s here ’ \\fimflg gs here Date: Secondplaimifllypes or prints name here Seconfplaimlflsigm here ( Requests for Accommodations ' Assistivc listening systems, computer-assisted mal-time captioning, or sign language interpreter , services axe available ifyou ask at least five days before the tn'al. Contact the clerk's office for foxm fi' 1 MC-410, RequeslforAccommodafians by Persons With Disabilities and Response. (Civ. Code, § 54.8.) “WWW” Plaintiff’s Claim and ORDER lo Go to Small Claims _Court 80-100. Page acts (Small Claims) 9 'SC-1 00 Information for the defendant (the person being sued) "Small claims court" ie a special court where claims tor $10 000 or less are decided. lndivxduala lncjugng''natuml persons" and gble proprietors may daii'n up to $10.000. Corpomtiona. pannetshipa. public entities. and othex businesses are limited to claims of $5.000. (See below lor exceptions.‘) The process is quick and Cheap The rules are slmplé and lnfounal. You ale the defendant-the person being sued The pamon who'Is suing you la the plaintiff Do I need a lawyer? You m_ay talk to a lawyer before or anet the case. But you may no! ha‘ve a lawyer represent you in court (unless thia'w an appeal llom a small claims case). How do I get ready for court? You don! have to ma any papers betore you! tnai, unless you think this Is the wwng court for ‘your case. But bnng to your tn'al any witnesses, receipts. and evidence that supports your case. And read 'Be Prepared for You: What if l need an accommodation? u you have a disability or are heanng Impaired fill out form MC-410. Request for Accommodations. Give' the fmm to your court dark or the ADA! Access Coordinators What If I don't speak Engll'sh well? Ask the court dark as soon as possible for a coun-ptovided interpretet. You may use form lNT-SOO or local court form tn request an interpreter. If a coun interpreter is not~availaue at the time of your Mai, ll may be necessary to reschedule you: ttial You cannot bxing your own Interpreter for_the Irlal unless Ihe Interpreter has been approved by thé court as a certified regiétered, or provisionalty quafified interpreter. (See Cal Rules 01 Court, ruleZ 893. and form INT-14o. ) Where can l get the court forms‘l need? Go to any courthouse or ygwggwmqomywqy gmmlibrgwry, or grigt forms at www. warfacegov/smellclaims/Iorms. What happens at the trial? The Judge wsu listen to both sides. The judga may make a decisi‘on at your trial or mail the decision to you_later What if I lose the case?|tyou Ioae. you may. appeal. You II _ have lo pay a fee. (Plaintiffs unnot appeal thait own claims. ) . H you were at the trial file form SC-140 Notice a_prpeaI. You must file within 30 days alter the clerk hands or mails-you the judge‘a decision (judgment) on form 80-200 or fon'n SC-130 Notice of Entry o! Judgment. . l! you were not at the trial, fill out and file form 80-135, Notice of Motion to Vacate Judgment and Dedaiayion, to ask the judge to cancel the judgment (decision). I1 the Judge does not give you a new trial, you have 10 days to appeal the decision. File term 80-140. For more informatlon on appeals sea www.courts ca gov/ smallclaims/appeals. Do l have options? Yea. If you are being sued. you can: ' Settle your case before the trial. n you and the plaintiff agree on how to settle the case. the plaintiff muat file torm CW4 10, Request for Dismissal, with the clerk. Ask the Small Claims Advisor for help. ' Prove this, is the wrong court. Sendsa Ietterto the court before yourrtrial explaining why you thing; 1mg is; the wrong coury Ask the coun to dismiss the dalm. You must serve (give) a copy of your letter (by mall or In person) lo all parties. (Your letter to the court must say you have done ep.) ' - Go to thy trial and try to win your case. a_ring case- To have the court order a witness to go to the trial, ml out form SC-107 [Smell Claims Subpgena) and have It served o_n the witnesa - Sue the person who ls suing you. Ityou have a cialm againsttha plaintiff and the claim'Is appropriate tor small claims (term 80-120) and bn'ng the claim In mla‘ action If your clalm‘Is for more than aflowed m small claims court you may still fi|e_ it En small clalma eéun l! you glve up thé amoum ove'r the émall daime value amount, or you May file a claim for the full value of the daim‘.n the appropnate court If your c_|__a!_m Is 10! more than allowed In small claims court and re1atee to the same oontrad, tlansacfion. matter. or eventthat la the §ubje'ct of the plélnfifi‘s motion to transfer the plalnmrs's claim to that court to resolve both matters together. You can see a descnption of the amounts aliowed In the paragraph above fithd "Small Clay”; Court." - Agree with the plalntlff's clglm and pay the money. 0r. I! you can’t pay the money now. go to your iris! and say you want to ma'kerpayménta; - Let the case "default." If you don't se‘tue‘and do notigo to the trial (delaull). the Judge may give the plaintiff whatshe or'she Is asking fox plus court costs. ll this happens. the plaintiff c_a_n legally take your money. wages, and properly to pay the judgment What if I need more time? You can change the trial date It: You cannot go to court on the schedued date (you win have to pay a fee to postpone the trial).or You dd not get served (receive this order to go to court) at least 15 days before the trial (or 20 days if you live outside tha coumy) or You need more tima to get an Interpreter. One poatponemant Is _ allwed, and you will not have {o pay a fee to delay the trial.; Ask the Small Claims Clerk about the rules and tees (or postponing a ltial OI fill out form 80-150 (or wnle a lefiet) and mall It to the court and to all other people listed on your court papers betore the deadline. Enclose a check for your court feast unless a fee waiver wan granted. Need help? ‘ Your county's Smau Claims Advise! can help for flee. [- "i .J Smaln=CIaims Adviser (408) 8822100, (Options 2. 6) Or go to www.oourts.m.gov/smallclaims/advisor. ' Exceptions: Different limits apply in an action against a defendant who Ia a guarantor. (See Code Civ. Proc., § 1 16.220(c).) Rnhnd Jammy 1. 2020 Plaintiff’s Claim and ORDER to Go to Small Claims Court 80-100. Page 4 of 5 (Small Claims) SC-1 00 L lnformaclén para el demandado (la persona demandada) La “Com do molamos muons" es una com- especial donda so decidan cases por S1 0,000- o manna. Los individuoa o saa- lea 'pamnas flms' y loo’ proplotarioo p'or cuenh ptopla. punden reclamar hash $10.000 Les corporaa‘onéé'. somaonea. gntidadea pubiicae ym: empress: solo puodon mdamér' ham 55.000 (Vea abajo para las excepclom'a.') El process ea 'répido y hereto Laa raglas 39o serge!!!“ e intoxmaloa; Uatod a_s oi Domandado-la persona qua 5'9 em derrisndando. La parsona qua lo 05w demandando ea al Damandantg wmglm un abogado? Puade hablafr con un abomdo antes o donpuba dol cam. Faro no puod'o tanér a un abog’ado q‘ue [a mpresanm ante la com (a menos qua so tram de una apeiac‘ién de un .f cm do redamos menoras). ¢Cémo me préparo pm Ir a la com? No tiena qu'e presenmr ningunoa papeles antes dol'juioio. a menus qua pjense quo éata es la carts equivocedp pam su case. Pero Save al_ Euicio cualquier tasfiaoa. recibos y pruebas qua a'poyan Bu case .Y Zea ’Esté pmpamdo pam s_u juieio' an www.courts}ea.goviradaniomenoreslprepanse. ¢Ou‘é hqgo al necoslto un_a ndaptaclén? Sl_ time una discapaoida‘d Requegt for Accomodahons, Enmguo ol formularlo al socremdo do la cone o a'l Coordina’dor do Awe'solADA do s‘u oorta mud pan sl no hahlo bien Inylfis? Soileite un Ihtbrprote al umbrlo de lg com lo més pronto posjbla‘ Puede uaar nl formuinrlo‘ INTQOO o un formularlo de su com local. Si no nu dfspcnlblo un intérpmm de la aorta pa‘m su juicio. e‘e posible que se tenga qua Gambler la facha do sujuiaé No puoda Reva: su propio interprets para el juicio a menus que el iniérprete haya aldo aprobado par Ia corta' oomo un Interprets oertifieado; rogistrado. o provisiohalmante calificado. (Voa la rowan2.893 do Isa Roglaa d5 Ia Com de California, y el formulado IN‘M 40) m_bnde puqdo obtener lo: tormularloa do Ia com qua neceslto? Véyé a cuélquier édifieio defa com Ia. bib'llofiéca legal dow oondsdo o imprlma Ina tormularion on www;damn gov] amallclaims‘florma (pagina om en ingiés).. I (nub pan an cl lulclo? EI‘juoz escucharé a ambaa paths. Et‘jusz puade tamer au decision duranh la audiqneia o enwérsela por oorreo déapuée. ¢Oué pas: s! plerdo cl cue? Si pierdh, puede apalar Tandra quo pagnr una cuola. (El Daman'dante no puade apela‘r cu propio radamc ) . Si omuvo present; en el iulcio. lone ol formmariq 80-140. Avian d9 ‘opelacion (Noh‘oo of Appeal). Tleno qua preunmflo denho do 30 dlas despuée do que el eecrehrlo Io entegue o envle lg decision (fnllo) del juez en cl tonnaiatio 80-200 o 80130. Aviso do publicacldn d9! fella (Nofieo'bf Entry of Judgment). . Si no asmvo an el juido, Ilene y pmsonte a! formulario 50-135. Avian do potloidn para anular eI lallu y Dodameidn para padlrie al juoz qua anulo el faflo (daciaibn). Si la cone no Ia otorga un nuevo juicio, fiene 1O dlas para apelar la ded'sibn, Presents el formulano 30-140. Para obbnar més informacibn sobre Ins apelaciones. vea www. courts ca.govindamosmonoros/apalocionés. Henge ouas opclonea? S1. Si lo ostén demandando‘ puede: . Resolver su cue antes del julclo. Si usted y at Demandante as ponen do scumdo en cbrno resolve! el case. el Damandanu fiene que prosenzar el rormulario CIV-110. Soticitud de deacflimadbn (Requegt for Dismissal) ante el sammrio d9 Ia cone Pldaee al A3080! do Rechmoa Menores qua lo ayude . Pmbar qua es l'a com equivocadyg Envlo una cart; a, _|a corte- antes dal ‘picio expiicgndo por qua et'ee qua es la cone oquivoqada. Pldalo a la com qua deapida el redamo.Tlena qua tédas Isa pamo, (Su cam a la com fiene qua decir qua hizo Ia_ ontogn'. ) . Ir al jump y tram do gaunt cl es_so. Lbyo games. reqbos y cuatquiev prueba qua necosfna para prubér su gasp. Si do_saa qua Ia cone 9mm una ordén do eomp'are'cencia para quo los teab‘gos vayan el juioio Hana ul formuiarlo sc-107. Gitafon’q do mdamos , msfigo. . Demandar a la per’sona qua Io demandé. Si-fien‘a’ un r'edamo cohtm 9| Damandante. y el raclaino ae puodo prounhr en-la com do roclamoa menores, ufl oomo s_o describe en eats formuiatio puede presenmr oi fon'n'ulario 50-120 Rada’mo do! domandado (Defendant's Ciaim) y pmaonmno en eats miamo case. SI su rec_lamo excado el limits permjfldo en la cone da reclamos manor", pueda igmlmnb presentarlqen la com do reclamos manom a” e'sfi. dlspua'nto a‘ limimrw racia’mo 'al Maximo potmmdo o puado prgunhr un reclamo por el monto total on la com apropiada. Si a'u rodamo oxoodo olllmiu ' permitido an Ia eons da raciamoz’ niénom y dam re‘la'donado con at mlemo comma. Vanuodén, asunm o aeonheln'fiam qua ol reclamo da_l Damandanb. puoda' 'prugnfir Bu melamo _en Ia aorta apropiada y pr'oaentar una mocibn para tendon“! o! raciamo do_l Demandantb a dlcha cone, para poder resolve? Ion doe' reclamoq juntos Puode .ver unadescripciOn do lo: montoa pormnhdos on o] pénafo antenor tituIado ‘Corle d9 raclamos menoro's'. V‘ . Aapur cl roclamo dal O_gmamllnla y pageral dinero. O, ci no hamr loa pages. . . No Ir al julclo y acepmr 0| lallo por tall: do oompamcenclq. Si no Ilega a un aeuetdo con a! Domandaqta y no va al Juicio (fafib por Ialt'a do comparecenda);9| Juaz Ia puedo otorg'ar al Demandanta 10 qua em redaméndo mas Ins eos’bo dc la pom En ese cam, ol Domandanta legalmente pusda tomar su dimm- su suoido o wo bienee para oobrar ’e} tallo V (,Oué hano 3| nocoslto mas flempo? Puede- cambiar in facha da} jmcio si. - No pueda ir a in com on in focha programada (tundra qua pager un'a cuotn para aplazar 6! jui'cio}. o ~ No lo entegaron lo; documanto's logarmente (no_ reclblo :{a ordan p_ara w a la cone) pot Io menus 16 dl'as. antes dot'juicio (6 20 dfaa 3i viva fuer- dal oondado). o - Nemsim inks fi'empo para eonsegulr infirpreto (So permits un solo aplazamionm sin tuner qua pager cuom para aplazgr al u Clo Prnlguntgie al secrahrio do rodamos mpmms-sqbra Ins raglan y [as ounces para apIaznr un julaio. O itone alformular'io sc-150 (d ascribe una curb) y envlelo arms dal plazo a_ {a carts y a Iodaa Ian aims pmaonas que figumn en sue papelos do fa corps Adjunm un cheque para pagar lo: coma do la com. a monoa qua Ia hayan dado una exoncibn. (,Necgslm ayuda? El Aeasor do Redgmos Momma do su condado la puede ayudat singearao, SmaH-Claims Adviser (408) 882-2100, (Options 2, 6) J O visits www.couflsm.gov/radamosmonomyasosoras, ' anpclonnt Ex‘umWu Inn on un locummu un 9mm Nu e!W bMW Chi. uncut: 11830 (c)) Rm Mmy 1,2020 Reclamo del Demandante y ORDEN SC-100. Pegs 5 o! s Para Ir a Ia Cone de Reclamos Menores (Reclamos Menores) SC'1 03x - Fictmous Business Name 2 QBS @fi 35 2' 9V33' mgsrgmisauacmmo: El Form sc-loo 0R D Form sc-lzo ® If you want to Illa a smal! clalm and you are doing business under a fictltlous name (“doing businesshs,“ or “dba”) give the tollowlng Intormatlon. (Nonprofits and exempt real estate investmen! trusts do not have to le :hiséonn$ANGO RCAL. a Callfomla domestic nonprofit corporation. doing business as Business name of the person suing: 1H5 TERRACES AT LOS ALTOS Business address (no! a U.S. Postal Service P.0. Box): 323 Ping Lgng‘, Lg; Aug, QA £932 Mailing gédresgfifdifierem): ® The buslness llsted In® does buslnéss as (check ONLYone): D an individual m acorporation D anassociation D alimitcdliability company D a_pannership B other (specim: You mustfollow the lawsforfictiu’om business names. Ifyou have nntfallowed these laws includingfiling a fictitious bu.Vines: name statemen! in your county andpublishing thi.v information m a 10ml newspaper. the court can dismiss your case. ® Name of county where you filed your Ficiltlous Business Name Statement (dba): ' Santaflmmuntv ® Your Flctltlous Buslness Name Statement number: FBN342151 ® Date your Flctmous Business Name Statement expires:Mav 10. 2023 I declare. under penalty of perjury under California State law. that Lhc information above is true and correct. ' \ ) k 97k \OKV‘MNQJ Type tyournamea tire b Sign®ymeQU\ffidor I ®Your county's Small Claims Advisor can help for free. [ Snldii-Ciaims Adviser I (408) 882-2100, (Options 2, 6) I I Or go to “County-Spccific Court Infomation" at: www.courlinfo.ca.govkeljhelp/smallclaims W‘thm3'"me Fictitious Buslness Name 30403: P8931 0"mehnuuy hm.Wm! Form W am.- Coaaomu9mm“ nuao. (small Claims) h.” 801ml: Ird Pmleuiom 0066.9 ”Md lag.
