Request DismissalCal. Super. - 6th Dist.March 2, 202121 CV378996 Santa Clara - Civil R. Nguyen -|n-+Fen-lea"y Filed ClV-‘HO -IGVI ATTORNEY 0R PART? szHOUT ATTORNEY: STATE BAR No: 293970 Y NAME: Bream DH Cortes by Superi5°r3EWIWW CA, FIRM NAME; Attorney at Law County of Santa Clara, STREETADDRESS: 12393 Sunnygien Drive 3n 9/29/2021 12:37 PM CW Moorpark STATE: CA Z'F’CODE: 93021 Reviewed By: R. Nguyen TELEPHONE N0; 310-800-3445 FAX No: NA E-MAIL ADDRESS: bree@bdhc!egai.com ATTORNEY FOR {Name}: VANESSA PAGADUAN SUPERIOR COURT OF CALIFORNIA, COUNTY 0F SANTA CLARA STREET ADDRESS: 191 N. First Street MAILme ADDRESS: Same CITY AND ZIP CODE: San Jose 951 1 3 BRANCH NAME: Downtown Superior Court PlaintiffiPetitioner: VANESSA PAGADUAN Defendanthespondent: HCA MANAGEMENT, ET AL. 1 | Case #21 CV378996 Envelope: 7364577 CASE NUMBER: REQUEST FOR DISMISSAL 21CV378996 A conformed copy will not be returned by the clerk unless a method of return is provided with the document. This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action in a class action. (Cal. Rules of Conrt, rules 3.760 and 3.770.) 1. TO THE CLERK: Please dismiss this action as fotlows: a. (1) E \Ntth prejudice (2) E: Without prejudice b. (1) DZ] Complaint (2) E Petition (3) D Cross-compiaint filed by (name): 0n (date): (4) E Cross-complaint filed by (name): on (date): (5) w Entire action of ail parties and all causes of action (6) E Other (specifix):* 2. (Complete in ah' cases except family law cases ) The courtE did -did not waive court fees and costs for a party in this case. (This information may be obtained from the clerk. If coun‘ fees and costs were waived the declaration on the back of this form must be compfeted). Date:9f28/21 -. Breann DH Cortes } {TYPE QR PRENT NAME OF I X I ATTORNEY I I PARTY WTHOUT ATTORNEY) (SIGNATURE) *[f dismissai requested is of specified parties only of specified causes of action only, Attorney 0r party Without attorney for: or of specified cross-compiaints oniy, so state and identify the panies, causes of E plaintifflpefitioner E DefendanflRespondent acticn, or cross-compiaints to ba dismissed. a Cross Complainant 3. T0 THE CLERK: Consent to the above dismissal is hereby given.“ Date: 9128/21 ‘ gammyDH C0113? Breann DH Cortes > Br (TYPE OR PRINT NAME OF I X I ATTORNEY I I PARTY WITHOUT ATTORNEY} (SIGNATURE) ** If a cross-compiaint - or Response (Famiiy Law) seeking afiirmative Attorney or party without attorney for: relief” is on fife, the attorney for cross-complainant (respondent) must sign E Pfaintifflpetitioner E DefendanflRespondentthis consent if required by Code of Civil PrOCEdure sectlon 581 (I) or (j). D Cross Complainant (To be compfeted by clerk) 4. [J Dismissa! entered as requested on (date): 5 E] Dismissaf entered on (date): as to only (name): 6. E Dismissal not entered as requested for the fotlowing reasons (specfflx): 9/29/2021 12:37 PM 7. a. [XE Attorney or party without attorney notified on (date): 909/2021 12:37 PM b. E Attorney or party without attorney not notified. Filing party failed to providea a copy to be conformed E means to return conformed copy Date; 9/29/2021 12:37 PM 019mm; R-Nguyen ,Deputy Pagan” F Adtdert U Cod fC“IP d .5311 .;G_Cd, Jfifli‘lia.32:mi.°3rci?i£n‘;2 59 REQUEST FOR DISMISSAL a°§é$e§3§?c‘;f§mes;€:ui$33130 CIV-‘l 1D {Rem Jan. 1, 2013] wmmomfaca‘gov CIV-110 . . . . _ CASE NUMBER: PlaintlfflPetItloner. VANESSA PAGADUAN 210878996 DefendantiRespondent: HCA MANAGEMENT, ET AL. COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS If a party whose court fees and costs were initiaily waived has recovered or wiil recover $10900 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 untii 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 ‘I is (check one below): a. E not recovering anything of value by this action. b. [:1 recovering fess than $10,000 in value by this action. c. [j recovering $10,000 or more in value by this action. (Ifitem 20 is checked, item 3 mustbe compiefed.) 3. [:1 AI! court fees and court costs that were waived in this action have been paid to the court (check one): Yes N0 I deciare under penalty of perjury under the laws of the State of California that the information above is true and correct. ) Date: {TYPE 0R PRINT NAME 0FE ATTORNEY E PARTY MAKING DECLARAmN) {SIGNATURE} cwmcmev. January 1‘ 2013] REQUEST FOR msmss‘qL Page 20:2