Plaintiff s Claim Amended No change in no claim amountCal. Super. - 6th Dist.March 10, 2020“WE ”mew 5-52.? “ Plaintiff's Claim and ORDER Clerk stamps date here when formis filed. SC-1 00 to Go to Small Claims Court _:- 5‘ r; Notice to the person being sued: ' You are the defendant if your name is listed in® on page 2 of this form. The person suing you is the plaintiff, listed in® on page 2. ' You and the plaintiff must go to court on the trial date listed below. If you do not go to court, you may lose the case. ' If you lose, the court can order that your wages, money, or property be taken to pay this claim. ° Bring witnesses, receipts, and any evidence you need to prove your case. Fm in com name and street address.- ' Read this form and all pages attached to understand the claim against you SUperior c°unS°afnf:gfl:;:ia’ county Of and to protect your rights. Downtown Superior Court Aviso al Demandado: ' Usted es el Demandado si su nombre figura en® de 1a pégina 2 de este 191 N°“h Fir“ Street fonnulario. La persona que 10 demanda es e1 Demandante, 1a que figura en 3a“ Jose: CA 95113 CD de la pagma 2' Court fills in case number when form is filed. . p§t§d y e1 Demandan'te tleglen qup presentarse en 1a corte en 1a fecha del y CasENfi mbrgmwig :3 fl 0 ”:l mJulc10 1nd1cada a contmuacwn. Sx no se presenta, puede perder el caso. .4; \ f; .-. ' Si pierde el caso la corte podria ordenar que le quiten de su sueldo, dinero u Case Name: . A Paul Losch v. Cedar Crest Nursing &otros blenes para pagar este reclamo. Rehabilitation Center ° Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso. ' Lea este formulario y todas las péginas adjuntas para entender la demanda en su contra y para proteger sus derechos. The people"In @ and ® must go to court. (Clerkfills outsection below ) Trial -> Date Tinvle Department Name and address of court, if different from above Date Lullailzv )4?me W 2 3. r, "\ p Date: MA! :| ‘] leZH Clerk, by [jjl/YVI/L “\x 4AA , Deputy Instructions for the person suing: A GRANADS - You are the plaintiff. The person you are suing is the defendant. - Before you fill out this form, read form SC-lOO-INFO, Informationfor the Plaintiff, t0 know your rights. Get SC-lOO- INFO at any courthouse or county law library, or go t0 www.courts.ca.gov/smallclaims/forms. - Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Make one 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 of your trial in the box above. - You must have someone at least 18-not you 0r anyone else listed in this case-give each defendant a court-stamped copy of all five pages of this form and any pages this form tells you to attach. There are special rules for “serving,” or delivering, this form to public entities, associations, and some businesses. See forms SC-104, SC-104B, and SC-104C. - G0 to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. JudicialCouncilofCalifarnia. www.courfs.ca.gov Plaintiff's Claim and ORDER SC-100, Page 1 0f5 Revised January 1, 2020. Mandatory Form Code ofCivilProcedure,§§ 116.110 etseq., to Go to Small Claims Court 9 116.220(c), 116340(g) ( alC lai s . a w Generated by Guide and File M Sg Kfir; mm gv «Km y} NIDMEEISLPugsi; Plaintiff (list names): Paul Losch SC 100 Item 3 .Cas {J‘m 3! Numbe : , . ..' f? “"‘s: 6‘31. ea"! (”I 3‘K CD The plaintiff (the person, business, or public entity that is suing) is: ® The plaintiff claims the defendant owes $ $131.00 Name: Paul Losch Phone: 415-269-1427 891 Lincoln Ave Palo Alto, CA 94301-3333 Street City State Zip Mailing address (ifdifikrent): Street address: Street City State Zip If more than one plaintiff, list next plaintiff here: Name: Phone: Street address: Street City State Zip Mailing address (ifdz'flerent): Street - City State Zip D Check here ifmore than two plaintiff? and attachform SC-I 00A. D Check here ifeither plaintifflisted above is doing business under afictitious name. Ifso, attachform SC-103. Q Check here ifany plaintijfis a ”licensee " or “deferred deposit originator ” (payday lender) under Financial Code sections 23000 et seq. The defendant (the person, business, or public entity being sued) is: Name: Cedar Crest Nursing & Rehabilitation Center - Phone: 408_73 84880 Street address: 797 East Fremont Ave. Sunnyvale, CA 94087 Street City State Zip Mailing address (ifdiflerent): Street City State Zip lf the defendant is a corporation, limited liability company, or public entity, list the person or agent authorized for service of process here: - f7'fimflfimfi _._- ~--~-\ . . ..,.~--,--'-:-r “vKWTI‘acw‘Mum ' @fwm‘.”‘wfgflnie‘ifknowfiwmmiw Add£a§gerz91EasrrgnerfiafirAx/e. ' 7" M ' CA 921687433" EfrEeT" City State Zip D Check here ifyour case is against more than one defendant, and attachform SC-I 00A. D Check here ifanv defendant is on active militarv dutv. and write his 0r her name here: . (Explain below): a. Why does the defendant owe the plaintiff money? I entered Cedar Crest for physical rehab after I broke my shoulder 0n 1/19/2020. My personal belongings, including my shoes, were placed in patient bags at E1 Camino Hospital, ,whereI initially stayed, and were transferred with me to Cedar Crest When did this happen? (Date): b. If no specific date, give the time period: Date started: 1/22/2020 Through:3/3/2020 c. How did you calculate the money owed to you? (Do not include court costs 0r fees for service.) Price paid for shoes Revised January 1. 2020 Plaintiff’s Claim and ORDER to Go to Small Claims Court 3°40“) P3962 °f5 (s a_n Qlaim§) L, 9 fig? 5W mg! . ' g] 5“: 1‘" .'.~,..;‘:... .3: ?_i w“ AMENDMENT Plaintiff (list names): *r ~ I fl: y" "'7: " 1i n? g "25 4.3%. ‘ L W [Q Xi? (Ea 51;». 81:; 9&7 £33 ® You must ask the defendant (in person, in writing, or by phone) to pay you before you sue. If your claim is for possession of property, you must ask the defendant to give you the property. Have you done this? Yes D No If no, explain why not: Paul Losch ® Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. (l) Where the defendant livés or does business. (4) Where a contract (written or spoken) was made, (2) Where the plaintiff‘s property was damaged. signed, performed, 0r broken by the defendant or (3) Where the plaintiff was injured. where the defendant lived or did business when the defendant made the contract. b. Q Where the buyer 0r lessee signed the contract, lives now, or lived when the contract was made, if this claim, is about an offer or contract for personal, family, or household goods, services, or loans. (Code Civ. Proc., § 395(b).) c. D Where the buyer signed the contract, 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. Q Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle is pelmanently garaged, if this claim is about a vehicle finance sale. (Civ Code, § 2984.4.) e. U Other {specifi}: List the zip code of the place checked in © above (ifyou know): ‘ 94087 ls your claim about an attorney-client fee dispute? E] Ygs No Ifyes, and z'fyou have had arbitration, fill outform SC-I 01, attach it to thisform, and check here: D Are you suing a public entity? D Yes No Ifyes, you mustfile a written claim with the entityfirst. D A claim was filed on (date): Ifthepublic entity denies your claim or does not answer within the time allowed by law, you canfile this form. Have you filed more than 12 other small claims within the last 12 months in California? D Yes No Ifyes, thefilingfeefor this case will be higher. ls your claim for more than $2,500? D Yes No Ifyes, I have notfiled, and understand that I cannotfile, more than two small claims casesfor more than $2,500 in California during this calendar year. I understand that by filing a claim in small claims court, | have no right to appeal this G®® 66> claim. I declare, under penalty of perjury under California State law, that the information above a1 on/ y ttachments to this form is true and correct. V $3Date: 3/1 0/2020 Paul Losch >ls/ Paul Losch “I ' \ Plaintifj’glpes 0r prints name here Plaintiffsigns heré Date: } r Secondplaintifftypes 0r prints name here Secondplaintfisigns here Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available ifyou ask at least five days before the trial. Contact the clerk’s office for form MC-410, Requestfor Accommodations by Persons With Disabilities and Response. (Civ. Code, § 54.8.) Re“‘““"""“’”°2° Plaintiff’s Claim and ORDER to Go to Small Claims Court 36-100, PageSof5 (Small Claims) 9 AMmeEr SC-100 Information for the defendant (the person being sued) "Small Claims court" i8 a Special court Where Claims for ' Prove this is the wrong court. Send a letter to the court $10,000 0r less are dBCided- IHdiVidUEIS. inClUding "natural before your trial explaining why you think this is the wrong court. persons" and sole proprietors, may claim Up to $10.000. Ask the court to dismiss the claim. You must serve (give) a copy Corporationsu PartnerShiPS. PUbliC entitieS. and Other bUSinesseS of your letter (by mail or in person) to all parties. (Your letter to are limited to claims of $5,000. (See below for exceptions.*) The the court must say you have done so_) process is quick and cheap. The rules are simple and informal. , Go to the trial and try to win your case_ Bring You are the defendant-the person being sued. The person who is suing you is the plaintiff. witnesses, receipts, and any evidence you need to prove your case. To have the court order a witness to go to the trial, fill out DO I head a lawyer? You may talk t0 a lawyer before 0r after form 80-107 (Small Claims Subpoena) and have it served on the case. But you may not have a lawyer represent you in court the witness. (unless this is an appeal from a small claims case). . Sue the person who is suing you. If you have a claim HOW d0 I get ready for court? YOU don't haVe t0 file any against the plaintiff, and the claim is appropriate for small claims papers before your trial, unless you think this is the wrong court for court as described on this form, you may file Defendant’s Claim your 0359- BUt bring t0 your trial any Witnesses: reCEiPtS- and (form 30-120) and bring the Claim in this aCtion. lf your Claim is evidence that SUpportS your case. And read "Be Prepared for YOUI" for more than allowed in small claims court, you may still file it in Trial" at WWW~COU’TS-Ga-QOV/Sma/IC/aimS/Prepare- small claims court if you give up the amount over the small What if] need an accommodation? If you have a claims value amount, or you may file a claim for the full value 0f the claim in the appropriate court. If your claim is for more than allowed in small claims court and relates to the same contract, transaction. matter. or event that is the subject of the plaintiff's claim, you may file your claim in the appropriate court and file a disability or are hearing impaired, fill out form MC-410, Request for Accommodations. Give the form to your court clerk or the ADA/ Access Coordinator. What 'f I don’t Speak Engl'Sh we"? ASk the court Clerk motion to transfer the plaintiff's 's claim to that court to resolve as 50°” as POSSib'e for a court'PFOVided interpreter- Y0” may use both matters together. You can see a description of the amounts form |NT-300 or local court form to request an interpreter. If a allowed in the paragraph above titled “Small Claims Court" court interpreter is not available at the time of your trial, it may be _ , _ . necessary to reschedule your trial. You cannot bring your own ' Agree W'th the Plamt'ffls Cla'm and Pay the interpreter for the trial unless the interpreter has been approved money. Or, if you can't pay the money now, go to your trial by the court as a certified. registered, or provisionally qualified and say you want to make payments. interpreter. (See Cal. Rules of Court, rule 2.893, and form " Let the case "default." If you don't settle and do not go to the trial (default). the judge may give the plaintiff what he or she is asking for plus court costs. lf this happens, the plaintiff can legally take your money, wages, and property to pay the lNT-14o.) Where can l get the court forms i'need? Go to any courthouse or your county law library, or print forms at www. courts. ca.gov/sma/lc/aims/fonns. judgment. What happens at the trial? The judge will listen to both What if I need more time? Side_s: The judge may make a decision at your trial or mail the You can Change the trial date if: dec's'on t0 you later' You cannot go t0 court on the scheduled date (you will have t0 What ifl lose the case?” you lose, you may appeal. You'll . pay a fee to postpone the trial), or have to pay a fee. (Plaintiffs cannot appeal their own claims.) You did not get served (receive this order to go to court) at least . If you were at the trial. file form SC-140, Notice oprpeal. You . 15 days before the trial (0r 20 days 'f YOU “V9 OUtSIde the must file within 3O days after the clerk hands or mails you the commo judge's decision (judgment) on form 80-200 or form 30-130, You needrmore time to get an interpreter One postponement is Notice Of Enm, Of Judgment allowed and you will not have to pay a fee to delay the trial. Ask the Small Claims Clerk about the rules and fees for postponing a trial. Or fill out form SC-150 (or write a letter) and mail it to the court and to all other people listed on your court papers before the deadline. Enclose a check for your court fees, . If you were not at the trial, fill out and file form 80-135, Notice of Motion to Vacate Judgment and Declaration, to ask the judge to cancel the judgment (decision). If the judge does not give you a new trial, you have 10 days to appeal the decision. File form 30140- unless a fee waiver was granted. ‘ ~ V For morg information on appeals. see www.courts.ca.gov/ Need help? smallCIa’mS/appeals' Your county's Small Claims Advisor can help for free. Do | have options? Yes. If you are being sued, you can: (408) 882-2100 (Option #2 then #6) ' Settle your case before the trial. Ifyou and the Plaintiff agree 0n how t0 settle the case: the Plaintiff mUSt file http://www.scscourt.org/self_help/small_claims/small_claims_advis form CIV-1 10, Request for Dismissal, with the‘clerk. Ask the nr shtml Small Claims AdViSOF for help- ' Or go to www.courts.ca.gov/smallclaims/advisor. * Exceptions: Different limits apply in an action against a defendant who is a guarantor. (See Code Civ. Proc., § 116.220(c).) Re“$““"“a”"2°2° Plaintiff’s Claim and ORDER to Go to Small Claims Court 50100! Pa994°f5 (Small Claims) '9 I SC-100 Informacién para el demandado (la persona demandada) La ”Corte de reclamos menores" es una corte especial donde se deciden casos por $10,000 o menos. Los individuos, o sea las “personas fisicas" y los propietarios por cuenta propia, pueden reclamar hasta $10,000. Las corporaciones, asociaciones, entidades pL'Jblicas y otras empresas solo pueden reclamar hasta $5,000. (Vea abajo para Ias excepciones.*) El proceso es répido y barato. Las reglas son sencillas e informales. Usted es el Demandado-la persona que se esté demandando. La persona que lo esté demandando es el Demandante. (,Necesito un abogado? Puede hablar con un abogado antes o después del caso. Pero no puede tener a un abogado que lo represente ante la corte (a menos que se trate de una apelacién de un caso de reclamos menores). iCémo me preparo para ir a la corte? No tiene que presentar ningunos papeles antes del juicio, a menos que piense que ésta es Ia corte equivocada para su caso. Pero Heve a! juicio cualquier testigos, recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su juicio" en www.courts.ca.gov/reclamosmenores/preparese. LQué hago si necesito una adaptacién? Si tiene una discapacidad o tiene impedimentos de audicién, Ilene el formulario MC-410, Request for Accomodations. Entregue el formulario al secretario de la corte o al Coordinador de Acceso/ADA de su corte. ¢Qué pasa si no hablo bien inglés? Solicite un intérprete al secretario de Ia corte lo més pronto posible. Puede usar el formulario lNT-300 o un formulario de su corte local. Si no esté disponible un intérprete de Ia corte para su juicio, es posible que se tenga que cambiar la fecha de su juicio. No puede llevar su propio intérprete para el juicio a menos que el inte’rprete haya sido aprobado por la corte como un intérprete certificado, registrado, o provisionalmente calificado. (Vea la regla 2.893 de las Reglas de Ia Corte de California, y el formulario INT-140.) aDénde puedo obtener Ios formularios de Ia corte que necesito? Vaya a cualquier edificio de la co’rte, Ia biblioteca legal de su co'ndado, o imprima los formularios en www.couns.ca.gov/ smallclaims/forms (pa’gina esté en ingle’s). LQue’ pasa en el juicio? El juez escucharé a ambas partes. El juez puede tomar su decisién durante Ia audiencia o enviérsela por correo después. iQué pasa si pierdo el caso? Si pierde, puede apelar. Tendré que pagar una cuota. (El Demandante no puede apelar su propio reclamo.) . Si estuvo presente en el juicio, Ilene el formulario SC-140, Aviso de apelacio’n (Notice of Appeal). Tiene que presentarlo dentro de 30 dias después de que el secretario Ie entregue o envie Ia decisién (fallo) deljuez en el formulario 80-200 o SC-130, Aviso de publicacic’m del fallo (Notice of Entry of Judgment). . Si no estuvo en el juicio, Ilene y presente el formulario SC-1 35, Aviso de peticio’n para anular el fal/o y Declaracién para pedirle al juez que anule el fallo (decisién). Si la corte no Ie otorga un nuevo juicio, tiene 10 dias para apelar la decisién. Presente el formulario 80-140. Para obtener més informacién sobre las apelaciones, vea www. courts.ca.gov/rec/amosmenores/ape/aciones. aTengo otras opciones? SI'. Si lo estén demandando, puede: . Resolver su caso antes del juicio. Si usted y el Demandante se ponen de acuerdo en cémo resolver el caso, el Demandante tiene que presentar el formulario CIV-1 10, Solicitud de desestimacién (Request for Dismissal) ante el secretario de Ia corte. Pidale al Asesor de Reclamos Menores que lo ayude. . Probar que es la corte equivocada. Envfe una carta a Ia corte antes del juicio explicando por qué cree que es la corte equivocada. Pidale a la corte que despida el reclamo.Tiene que entregar (dar) una copia de su carta (por correo o en persona) a todas las partes. (Su carta a la corte tiene que decir que hizo la entrega.) . lr al juicio y tratar de ganar el caso. Lleve testigos, recibos y cualquier prueba que necesite para probar su caso. Si desea que la corte emita una orden de comparecencia para que Ios testigos vayan al juicio, Ilene el formulario SC-107, Citatorio de reclamos menores (Small Claims Subpoena) y entrégueselo legalmente al testigo. . Demandar a la persona que Io demandé. Si tiene un reclamo contra el Demandante. y el reclamo se puede presenter en la corte de reclamos menores. tal como se describe en este formulario, puede presentar el formulario 80-120, Reclamo del demandado (Defendant's Claim) y presentarlo en este mismo caso. Si su reclamo excede el limite permitido en la corte de reclamos menores, puede igualmente presentarlo en la corte de reclamos menores si esté dispuesto a limitar su reclamo al méximo permitido, o puede presenter un reclamo por el monto total en la corte apropiada. Si su reclamo excede el limite permitido en la corte de reclamos menores y esté relacionado con el mismo contrato, transaccién, asunto o acontecimiento que el reclamo del Demandante, puede presentar su reclamo en la corte apropiada y presentar una mocién para transferir el reclamo del Demandante a dicha corte. para poder resolver los dos reclamos juntos. Puede ver una descripcién de los montos permitidos en el pérrafo anterior titulado "Corte de reclamos menores". . Aeptar el reclamo del Demandante y pagar el dinero. O, si no puede pagar en ese momento, vaya al juicio y diga que quiere hacer Ios pages. NO‘ir al juiciQ y aceptar el fallo por falta de comparecencia. Si no llega a un acuerdo con el Demandante y no va al juicio (fallo por falta de comparecencia), el juez le puede otorgar al Demandante Io que esta’ reclamando més Ios costos de Ia corte. En ese caso, el Demandante legalmente puede tomar su dinero. su sueldo o sus bienes para cobrar el fallo. bQué hago si necesito més tie‘mpo? Puede cambiar la fecha del juicio si: - No puede ir a la corte en la fecha programada (tendré que pagar una cuota para aplazar el juicio), o - No Ie entregaron los documentos legalmente (no recibic’) la orden para ir a la corte) por Io menos 15 dias antes del juicio (é 20 dias si vive fuera del condado). o - Necesita més tiempo para conseguir intérprete. (Se permite un solo aplazamiento sin tener que pagar cuota para aplazar el JUICIo . Pregt’mtgle al secretario de reclamos menores sobre las reglas y las cuotas para aplazar un juicio. O Ilene el formulario SC-1 50 (o escriba una carta) y envfelo antes del plazo a la corte y a todas las otras personas que figuran en sus papeles de la corte. Adjunte un cheque para pagar Ios costos de Ia corte, a menos que le hayan dado una exencién. ¢Necesita ayuda? El Asesor de Reclamos Menores de su condado [e puede ayudar sin cargo. (408) 882‘2100 (option #2 then #6) http://www.scscourt.org/self_help/small_claims/smal1_claims_advisor.s hhm] O VISIte www.courts.ca.gov/reclamosmenores/asesores. ' Excopciones: Existen diferentes "miles en un reclamo contra un garante. (Vea el Cédigo de Procedimienlo Civil, seccibn 116.220 (6).) Revised January 1. 2020 Reclamo del Demandante y ORDEN SC-100, Page 5 of 5 Para Ir a la Corte de Reclamos Menores (Reclamos Menores) ”g MC-031 ___ PLAINTIFF/PETITIONER: PaulLosch v. CedarCrestNursing&Rehabilitation Center CA3?“ {imggg S g 8 Q; Efi flabDEFENDANT/RESPONDENT; ' W" J 5:" fl“ W ' DECLARATION (This form must be attached to another form or court paper before it can be filed in court.) SC-1 00, Item 3. Explanation of money owed continued: on 10%0 where a Cedar Crest e poyees signed for them. Some days later, I tried to retrieve myhshoes as part ofmy rehab, and they wer missmg When é a estd'd search and did not fi d the kisgng sho Algarranged for guother pair ofshoes be brought fiom home so (?‘u ck avet rrdT'formxethedar Cre teaims r&ywearched‘for th sho‘e‘sxad 1t19nal 1me_s~, and te6Q! never found them. I requested thaELiglfieinlburse they le'fu's d clgarlming thatifhad m' lEhoe "eVefitth gh thos¥\ exekthe secofid pai I‘lqad gotten from home and did not regm’érthe. escription ofthe sho’es:that had 0 e miSsi \g. Furthe“ whi1e=tliey\sai’d hey wére n‘otrliable for the missing shoes because I had the second pair, they offeréd to contin e to séarch for th'é ssing shoes, a flagrant'ifiicgnsmtency 1n message. / | declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: 03/1 0/2020 Paul Losch ls/ Paul Losch gflQM / (TYPE 0R PRINT NAME) (SIGNATURE OF DECLARANT) D Attorneyfor Plaintiff D Petitioner D Defendant D Respondent D Other (Specify): F°J$££$€Zfifié7298§fi$$$e ATTACHED DECLARATION MC-031 [Rev. July 1. 2005] Page 1 of1 I entered Cedar Crest {or physical rehab after! broke my shoulder on 1/19/2020. My personal belon s, in ding?fifihnes. were placed'm pallenl bags at El Camino. where] initially stayed. and were transferred with me to Cedar Crest on 1/22/2020. R '
