Request DismissalCal. Super. - 6th Dist.March 25, 202121 CV381 330 Santa Clara - Civil Clmflflflesca ATTORNEY 0R PARTY WITHOUT ATTORNEY: STATE BAR No: 158088 FOR COURT USE ONLY :mEfiAEEASLvsil-Livv: Electronically Filed STREET ADDRESS: 2483 Old Middlefield Way, Suite 206 by SUperior court 0f CA, CITY: Mountain View STATE: CA ZIP CODE: 94043 County of Santa Clara, ”EM” “0* (65°) 861-8868 WW (650) 691-3914 on 1120/2022 6:09 PM E'MA'LADDRESS: Charles@'awand'aw'net Reviewed By: A. Floresca ATTORNEY F0R(Name): Plaintiff Sandra Henderson case #21 CV381 330 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: 161 N. First Street EnveIOPG: 81 04935 MAILING ADDRESS: 191 N. First Street CITY AND ZIP CODE: San Jose 951 13 BRANCH NAME:OId Courthouse PIaintiff/Petitioner: Sandra Henderson Defendant/Respondent: Santa Clara Valley Transportation Authority CASE NUMBER: REQUEST FOR DISMISSAL 21_Cv-381 330 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) With prejudice (2) E Without prejudice b. (1) E Complaint (2) E Petition (3) E Cross-complaint filed by (name): on (date): (4) E Cross-complaint filed by (name): on (date): (5) Entire action of all parties and all causes of action (6) Other (Specify).'* Each party to bear their own fees and costs. 2. (Complete in all 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 court fees and costs were waived, the declaration on the back of this form must be completed). Date; January18,2022 CHARLES LAW ’ gé ?_h (TYPE 0R PRINT NAME OF ATTORNEY E PARTY WITHOUT ATTORNEY) (SIGNATURE) *lf dismissal requested is of specified parties only of specified causes of action only, Attorney 0r party Without attorney for: or of specified cross-complaints only, so state and identify the parties, causes of plaintiff/petitioner E Defendant/Respondent action, or cross-complaints to be dismissed. E Cross Complainant 3. TO THE CLERK: Consent to the above dismissal is hereby given.** Date: ’ (TYPE 0R PRINT NAME OF E ATTORNEY E PARTY WITHOUT ATTORNEY) (SIGNATURE) ** If a cross-complaint - or Response (Family Law) seeking affirmative Attorney 0r party Without attorney for: relief - is on file, the attorney for cross-complainant (respondent) must sign E PIaintifi/Petitioner E Defendant/Respondentthis consent if required by Code of Civil Procedure section 581 (i) or (j). E Cross Complainant (To be completed by clerk) 4. Dismissal entered as requested on (date):1/20/2022 5109 PM 5 E Dismissal entered on (date): as to only (name): 6. E Dismissal not entered as requested for the following reasons (specify): 7. a. E Attorney or party without attorney notified on (date):1/20/2022 6509 PM b. E Attorney or party without attorney not notified. Filing party failed to provideE a copy to be conformed E means to return conformed copy A. Floresca Date: 1/20/2022 6:09 PM Clerk, by , Deputy Page 1 on Form Adopted for Mandatory Use Code of Civil Procedure, § 581 et seq.; Gov. Code, Judicial Council of California REQUEST FOR DISMISSAL § 68637(c); Cal. Rules of Court, rule 3.1390 ClV-110 [Rev. Jan. 1, 2013] www.courts.ca.gov CIV-1 1 0 CASE NUMBER: Plalntlff/Petltloner: Sandra Henderson 21 {V381 330 Defendant/Respondenti Santa Clara Valley Transportation Authority 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 court fees and costs in this action for (name): 2. The person named in item 1 is (check one below): a. E not recovering anything of value by this action. b- E recovering less than $10,000 in value by this action. c. E recovering $10,000 or more in value by this action. (Ifitem 20 is checked, item 3 must be completed.) 3. E A|| court fees and court costs that were waived in this action have been paid to the court (check one): Yes No | declare under penalty of perjury under the laws of the State of California that the information above is true and correct. D (TYPE 0R PRINT NAME 0F E ATTORNEY E PARTY MAKING DECLARATION) (S'GNATURE) Date: Clv-11o [Rev. January 1, 2013] REQUEST FOR DISMISSAL Page 2 of2