Request DismissalCal. Super. - 6th Dist.May 3, 202121 CV381 248 Santa Clara - Civil CIV-1 1 0 A‘I'I'ORNEY OR PARTY WITHOUT A‘I'I'ORNEY (Name, State Bar number. and address): Richard L. Mahfouz II (Bar No. 246739) FOR COURTUSE ONLY R- San 10“” Clerkin, Sinclailt'h& Mahfouz, LLP :30 BD_StreetC-:2 92:38: Electronically Filed an 'ego’ by Superior Court of CA, TELEPHONE No_: (619) 308-6550 FAX No. (Optional): (619) 923-3413 county of Santa Clara, E-MAIL ADDRESS (Optional): on 2,22,2022 10: 1 7 AM ATTORNEY FOR (Name): State Farm Mutual Automobile Insurance Company Reviewed By: R. Sandoval Case #21 CV381 248 Envelope: 8337097 SUPERIOR COURT OF CALIFORNIA. COUNTY 0F Santa Clara STREET ADDRESS: 191 North First Street MAILING ADDRESS: CITY AND ZIP CODE: San Jose, CA 951 13 BRANCH NAME: PLAINTIFF/PETITIONER: State Farm Mutual Automobile Insurance Company DEFENDANT/RESPONDENT: Soheil Shababi REQUEST FOR DISMISSAL CASE NUMBER: 21CV381248 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 Court, rules 3.760 and 3.770.) 1. TO THE CLERK: Please dismiss this action as follows: a. (1) E With prejudice (2) D Without prejudice b. (1) D Complaint (2) D Petition (3) D Cross-complaint filed by (name): on (date): (4) D Cross-complaint filed by (name): on (date): (5) E Entire action of all parties and all causes of action (6) D Other (specify):* 2. (Complete in all cases except family law cases.) The court D did X did not waive court fees and costs for a party in this case. (This information may be obtained from the clerk. If court fees and costs were waived, the declaration on the back of this form must be completed). Date: 2/1 8/2022 ~ Richard L. Mahfouz II, Esq. b xfm (TYPE 0R PRINT NAME 0F g ATrORNEY D PARTY WITHOUT A1TORNEY) 7 (S'GNATURE) *If dismissal reqqested is of specified parties only of specified causes of act'ion Attorney 0r party W'thOUt attorney for: only, or of speCIfied cross-complalnts only, so state and Identlfy the partles, E Plaintifi/Petitioner D Defendant/Respondentcauses of action, or cross-complaints to be dismissed. D Cross-Complainant 3. T0 THE CLERK: Consent to the above dismissal is hereby given.” Date: (SIGNATURE) Attorney or party without attorney for: (TYPE OR PRINT NAME OF D A'I'I'ORNEY D PARTY WITHOUT A'I'I'ORNEY) ** If a cross-complaint - or Response (Family Law) seeking affirmative relief- is on file, the attorney for cross-complainant (respondent) must - - - - sigr} this consent if required by Code of Civil Procedure section 581 (i) D Plalntlfi/Petltloner D Defendant/Respondent 0r (J)- D Cross-Complainant (To be completed by clerk) 4. E Dismissal entered as requested on (date .l22/2022 10:17 AM 5. D Dismissal entered on (date): as to only (name): 6. D Dismissal not entered as requested for the following reasons (specify): 7. a. E Attorney or party without attorney notified on (datefilZZ/ZOZZ 10117 AM b. D Attorney or party without attorney not notified. Filing party failed to provide a copy to be conformed D means to return conformed copy R. Sandoval 2/22/2022 10:1 7 AM Date: Clerk, by , Deputy [747948v1] Form Adopted for Mandatory Use REQUEST FOR DISMISSAL Page1 of2 Judicial Council of California Code of Civil Procedure, § 581 et seq.; ClV-1 10 [Rev. Jan. 1, 2013] Gov. Code, § 68637(c); Cal. Rules of Court, rule 3.1390 www.couninfo.ca‘gov CIV-110 _ PLAINTIFF/PETITIONER: State Farm Mutual Automobile Insurance Company gggEBthig/IBER: DEFENDANT/RESPONDENT: SOheil Shababi 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 a statutory lien on that recovery. The court may refuse to dismiss the case until the lien is satisfied. (Gov. Code, § 68637.) Declaration Concerning Waived Court Fees 1. The court waived fees and costs in this action for (name): 2. The person named in item 1 is (check one): a. D is not recovering anything of value by this action. b. D is recovering less than $10,000 in value by this action. c. D is recovering $10,000 or more in value by this action. (If item 20 is checked, item 3 must be completed.) 3. D All court fees and costs that were waived in this action have been paid to the court (check one): D Yes D No | declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: V (TYPE 0R PRINT NAME 0FD ATTORNEYD PARTY MAKING DECLARATION) (SIGNATURE) CIv-11o [Rev. Jan. 1, 2013] REQUEST FOR DISMISSAL Page 2 of2 [747948V1]
