Request DismissalCal. Super. - 6th Dist.March 30, 2021Electronically Filed by Superior Court of CA, County of Santa Clara, on 7/22/2021 1:06 PM Reviewed By: D Harris Case #21CV381524 Envelope: 6904595 21CV381524 Santa Clara - Civil D Harris 7/22/2021 1:06 PM 7/22/2021 1:06 PM X 7/22/2021 1:06 PM D Harris X CIV-110 PLAINTIFF/PETITIONER: Grant Mercantile Agency, Inc. CASE NUMBER: DEFENDANTIRESPONDENT: Jessica Bombaci, Jeffrey Bombaci, and Does 21CV381524 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 coult 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 1his action. b. E recovering less than $1 0.000 in value by this action. c. E recovering $10,000 or more in value by this action. (Ifitem 2c r's checked, item 3 must be completed.) 3.E All court fees and coun costs that were waived in this action have been paid to the coun (check one): a Yes D N0 | declare under penalty of perjury under the laws ofthe State of California that the information above is true and correct. Date: > (WPE 0R PRINT NAME 0Fm ATTORNEYD PARTY MAKING DECLARATION. (S'GNATURE) CIV7110[Rev‘January1,2013] REQUEST FOR DISMISSAL Page2012 Lc.\'r‘s.\'exr‘s-’;ID A utonmred Cah’forn {a Judicial Carma! Forms
