Request DismissalCal. Super. - 6th Dist.April 28, 2021Electronically Filed by Superior Court of CA, County of Santa Clara, on 8/26/2021 2:09 PM Reviewed By: A. Villanueva Case #21CV381114 Envelope: 7146551 21CV381114 Santa Clara - Civil A. Villanueva 8/26/2021 2:09 PM 8/26/2021 2:09 PM X 8/26/2021 2:09 PM A. Villanueva X ClV-1 10 PLAINTIFF/PETITIONER: UHG I LLC DEFENDANT/RESPONDENT: : Nicolle Marshall, an individual CASE NUMBER: 21CV381114 COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or more in value by way of settlement, compromise, arbitration award, mediation settlement, or other means, the court has statutory lien 0n that recovery. The court may refuse to dismiss the case until the lien is satisfied. (Gov. Code, Section 68637) 1. The court waived fees and costs in this action for (name): 2. The person in item 1 is (check one): a. E not recovering anything of value by this action. b. D recovering less than $10,000 in value by this action. C. D recovering $10,000 or more in value by this action. (/fiz‘em 20 is checked, item 3 must be completed.) 3.E AH court fees and costs that were waived in this action have been paid to the court (check one):E Yes D NO I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. OJM Date: August 18, 2021 Christopher D. Mandarich SB 220693 ’ (TYPE 0R PRINT NAMEOPE ATTORNEYE PARTY MAKING DECLARATION) \«w. (SIGNATURE) ClV-11O [Rev January 1, 2013] REQUEST FOR DISMIISSAL Page 2 of 2
