Request Dismissal

Cal. Super. - 6th Dist.April 1, 2021

21 CV381451 Santa Clara - Civil MAILING ADDRESS: CITYANDZIPCODE: Sal’l Jose, CA 95113 BRANCH NAME: Downtown PLAINTIFF/PETITIONER: BRAYDEN LE, a Minor, By and Through His Guardi ad Litem, THANHTUYEN THI DINH DEFENDANT/RESPONDENT: GOOD SAMARITAN HOSPITAL; HCA HEALTH SERVICES OF CALIFORNIA; ALLISON CHAN, M.D., et al. CIV-1 1 O ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY b' ver KENNETH M. SIGELMAN, ESQ. (SBN 100238) SIGELMAN LAW OFFICES Electronically Filed 1901 First Ave. , 2nd Floor by Superior Court of CA,san Diego ’ CA 9%101 I County of Santa Clara, TELEPHONE No.: ( 6 1 9 ) 2 3 8 3 8 l 3 FAX No. (Optional): E-MAIL ADDRESS (Optional): on 12/3/2021 12:24 PM ATTORNEY FOR (Name): Pltf BRAYDEN LE, a Minor, by/ thru his GAL T. DINH RGViewed By: S- vera SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F Santa Clara Case #21 CV381 451 STREETADDRESS: l9 l N. First Street Envelope: 7786851 REQUEST FOR DISMISSAL CASE NUMBER: 21CV381451 A conformed copy will not be returned by the clerk unless a method of return is provided with the document. class action. (Cal. Rules of Court, rules 3.760 and 3.770.) 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 1. TO THE CLERK: Please dismiss this action as follows: a. (1)fl With prejudice (2)D Without prejudice b. (1)E Complaint (2)D Petition (3)D Cross-complaint filed by (name): (4)D Cross-complaint filed by (name): (5)D Entire action of all parties and all causes of action on (date): on (date): (6)m Other (Specify).'* As to Allison Chan, M.D., only. Each party to bear its own fees and costs. 2. (Complete in all cases except family law cases.) The court Ddid Edid 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). Data 12/02/2021 // ”1M 6 éKenneth..M.....Si.g.elma.n.,....Esq............................. > \ I ‘ (TYPE OR PRINT NAME OF ATTORNEY D PARTY WITHOUT ATTORNEY) NATURE) * If dismissal requested is of specified parties only, of specified causes of action Attorney 0r party Without attorney for: P l a i 1’1 t i f f S a.only, or of specified cross-complamts only, so_ s te and identify the parties, causes of actlon, or cross-complalnts to be dismissed. E PIaintifi/PetitionerD Cross-Complainant D Defendant/Respondent 3. T0 THE CLERK: Consent to the above dismissal is hereby given.** Date: b (TYPE OR PRINT NAME OF D ATTORNEYD PARTY WITHOUT ATTORNEY) ** relief-Is onfile,the attorne forthe cross-com Iainant es ondent must . . . . sig(rjI)this consent if require by Code of Civil Pl%cedure sec%on 581)(i) D Plalntlff/Petltloner or . D Cross-Complainant (SIGNATURE) If a cross-complaint - or Response (Family Law) seeking affirmative Attorney 0r party Without attorney for: r D Defendant/Respondent (To be completed by clerk) 4. m Dismissal entered as requested on (date): 5. D Dismissal entered on (date): 12/3/2021 12:24 P&é to only (name): 6. D Dismissal not entered as requested for the following reasons (specify): 7. a. a Attorney or party without attorney notified on (date):12/3/2021 12:24 pM b. D Attorney or party without attorney not notified. Filing party failed to provideD a copy to be conformed D means to return conformed copy S. Vera Datei12/3/2021 12:24 PM Clerk, by Pagefilgfuzty F AdtdfMdt u Cd row d ,581t .; cimiciacl)%gungirlofagalailfggiase CEB' Essential REQUEST FOR DISMISSAL Gov.Code,§686307(:)?CaIIYIRuIr§§%fggug,ruleesiggo CIV-110[Rev.Jan.1,2013] “Mom EFor-ms- www.courts.ca.gov Le.Chan CIV-1 1 0 PLAINTIFF/PETITIONER: BRAYDEN LE, a Minor, By and Through H CASE NUMBER: DEFENDANT/RESPONDENT: ALLISON CHAN, M.D. 21CV381451 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 $1 0,000 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 in item 1 is (check one below): a. D not recovering anything of value by this action. b. D recovering less than $10,000 in value by this action. c. D recovering $1 0,000 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: b (TYPE OR PRINT NAME OF D ATTORNEY D PARTY MAKING DECLARATION) (SIGNATURE) ClV-1 10 [Rev. January 1, 2013] CEB. Essential REQUEST FOR DISMISSAL ceb.com Em' Le.Chan Page 2 of 2