Request DismissalCal. Super. - 6th Dist.May 4, 2021Electronically Filed by Superior Court of CA, County of Santa Clara, on 7/12/2021 3:37 PM Reviewed By: R. Nguyen Case #21CV381486 Envelope: 6828848 21CV381486 Santa Clara - Civil R. Nguyen 7/12/2021 3:37 PM 7/12/2021 3:37 PM X 7/12/2021 3:37 PM R. Nguyen X ClV-110 PIaintiff/Petitioner; Acclaim Credit Technologies CASE NUMBER; Defendant/Respondent: Barbara Ann Olsen 21CV381486 COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS if a party whose court fees and costs were initially waived has recovered or wilt recover $10300 or more in value by way of settiement, compromise, arbitration award, mediation settlement, or other means, the couri has a statutory lien on that recovery. The court may refuse t0 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 1 is (check one below): a. E not recovering anything of value by this action. b. E recovering less than $10,000 in vaiue by this action. C. E recovering $10,000 or more En value by this action‘ (ifitem 20 is checked item 3 must be completed.) 3. E All com fees and coun costs that were waived En this action have been paid to the court (check one): Yes N0 l deciare under penalty of perjury under the IHWS 0f the Stale of California that the information above is true and correct. i (rYPE 0R PRINT NAME 0F E AWORNEY E PARTV MAKING DECLARATION) (S'GNATURB Date: CIV-HOlRev.Januar~/1,2013) REQUEST FOR DISMISSAL PageZof2
