Defendant s Claim 5001 to 10000Cal. Super. - 6th Dist.July 13, 2021i SC-1 20 Defendant’s C|aim and ORDER Clerksramps datehere when fonm‘s filed. ‘ to Go to Small Claims Court E L E - You must go to court on the trial date listed below. Ifyou do not go to court, SEP 2 4 2021 Y0" may 1°53 the case- Clérk of the Court - Ifyou lose, the court can order that your wages, money, or property be CM taken to pay this claim. Notice to the person being sued: ° You are being sued by the person you are suing. ~ Bring witnesses, receipts, and any evidence you need to prove your case. - Read this form and all pages attached, to understand the claim against Fm” co.” name end M99! add?” . Superior Court of California, County ofyou and to protect your rights. Aviso al demandado: Santa C|a_ra, CIVII-DIVISI0n, ° La e ona eh d dad l téd a d d td small Clalms' p rs q” a ema" ° 0 es em n a" ° a us e ‘ 191 N. First Street, San Jose, - Tiene que presentarse a la corte en la fecha de su juicio indicada a CA 951 1 3 continuacién. Si no se presenta, puede perder el caso. . . . . Fm in 0889 numeI’ and 0336 name:I SI plel‘de Bl 0350 la 00116 puede Ofdenal' que 16 QUltefl de SU SUCIdO, dlnel’O U '_c N I r: otros bienes para pagar este reclamo. 21 80085504 - Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso. o Lea este formulario y todas las pfiginas adjuntas, para entender la demanda en su contra y para proteger sus derechos. Order to Go to Court The people in (D and® must go to court: (Clerkfills oursecn'on below.) Trial 9 Date Time Department Name and address of court if different from above v I Date 119/21/31 ?’W /$ 2. 3 Date: Clerk, by t(757142 ,Deputyn “.4. . .1] U. UCTNIN'U' Case Name: Ruiz Ortis v. Pereira Instructions for the person suing: ' Before you fill out this form, read Form SC-lOO-INFO, Injbrmarionfor the Plaintifl, to know your rights. Get SC-lOO-INFO at any courthouse or county law library, 0r go t0: www.courtinfo.ca.gov/forms - Fill out pages 2 and 3 of this form. Then make copies ofall pages ofthis form. (Make l copy for each party named in this case and an extra copy for yourself.) Take 0r mail the original and these copies to the court clerk’s office and pay the filing fee. The clerk will write the date ofyour tn'al in the box above. ~ You must have someone at least 18-n0t you or anyone else listed in this case-givc each Plaintifi‘ a court-stamped copy 0f all 3 pages of this form and any pages this form tells you to attach. There are special rules for “serving,” or delivering, this form t0 public entities, associations, and some businesses. See Forms SC-l 04, SC-104B, and SC-104C. ° Go t0 court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case. JudidalCouncjlotCaMonfia, mmoounscagov Defendant’s CIaim and ORDER to Go to SC-120, Page1 of3 R ‘sedJanua 1.2011.Man¢alowF 'exampammmx Smgmgllf-Icqgmgfurt -> Case Number: Defendant (list names): John Roldrigues Pereira 21 80085504 ® The Plaintiff (the person, business, or public entity that sued first) is: Name: Martha Elena Ruiz Ortiz Phone= (408)9.9.0.6_5_5_5 Streetaddress; 101 W. Weddell Drive, #315 Sunnyvale CA 94089 Street City State Zip Mailing address (:fdifizrenr): P.O. Box 2589 San Jose CA 951 09 Street City Stare Zip If more than one Plaintiff, list next Plaintiff here: Name: Phone: ( ) Street address: Street City Stare Zip Mailing address (zfa'ifi'erent): Street City Stare Zip D Check here {fmore than 2 Plaintlfiis and attach Form SC-120A. D Check here {fany Plaintflis on active militatj/ duty and write his 0r her name here: ® The Defendant (the person, business, or public entity suing now) is: Name: John Rodrigues Pereira Phone: (408)5612338 Street address; 1980 E. San Antonio Street San Jose CA 951 16 Street City State Zip Mailing address ({fdtflkrent): Street City State Zr'p If more than one Defendant, list next Defendant here: Name: Phone: ( ) Street address: Street City State Zip Mailing address ({fdifl'erem): Sheet City State Zip D Check here {fmore than 2 Defendants and attach Form SC-IZOA. D Check here {feither Defendant listed above is doing business under afictitious name. Kso, attach Form SC-I 03. ® The Defendant claims the Plaintiff owes $6,000.00 .(Expzam below); a. Why does the Plaintiffowe the Defendant money? Plaintiff left the rental property in a damaged state. including broken cabinets, appliances, plumbing. heater, ceiling fans and yard landscaping. b. When did this happen? (Date): If n0 specific date, give the time period: Date started:M019- WroughflgmL- c. How did you calculate the money owed to you? (Do not include court costs orfeesfor service.)COSt 0f regairS and replacement items. D Check here ifyou need more space. Attach one sheet ofpaper or Form MC-031 and write "SC-I20, Item 3 ” at the top. RBViSBdJanuarv1«2°“ Defendant'ssmClaim and ORDER to Go to 80-120, Page 2 cg Claims Court (Small Claims) Case Number: 21 80085504 Defendant (list names): John Roldrigues Pereira ® You may ask the Plaintiff (in person, in writing, or by phone) to pay you before you sue. Have you done this? D Yes No © ls your claim about an attorney-client fee dispute? D Yes E No Ifyes, and {fyou have had arbitration, ff]! out Form SC-IOI, attach it t0 thisform, and check here: D © Are you suing a public entity? D Yes No Ifyes, you mustfile a written claim with the public enmyfirst. D A claim was filed on (date): Ifthe public entity denies your claim or does not answer within the time allowed by law, you canfile thisform. ® Have you filed more than 12 other small claims within the last 12 months in California?D Yes D No Eyes, thefllingfeejbr this case will be higher. I understand that by filing a claim in small claims court, l have no right to appeal this claim. ® If I do not have enough money to pay for filing fees or service, I can ask the coun to waive those fees. I have not filed, and understand that I cannot file, more than two small claims cases for more than $2,500 in California during this calendar year. l declare, under penalty of perjury under California State law, that the information above and on any attachments to this form is true and correct. Date; John Rodrigues Pereira } / Defendant types or prints name here Defe ' Date:?'2?-- 202/ ’ Second Defendant types 0r prints name here Defefigm‘ signs here V Requests for Accommodations Assistive listening systems, computer-assisted, real-time captioning, 0r sign language interpreter services are available if you ask at least five days before the tn'al. Contact the clerk’s office or go to mvw.c0urtinf0.ca.gov[forms for RequestforAccommodations by Persons With Disabilities and Response (form MC-410). (Civil Code, § 54.8.) Need help? Your county’s Small Claims Advisor can help for free. Or go to “County-Specific Court Information” at: www.courtinfo. ca.gov/seb‘hehy/smallclaims WWWWUW Defendant’s Claim a_nd ORDER to Go to 30-120, Page 3 0f 3 Small Claims Court (Small Claims)
