request for dismissalCal. Super. - 1st Dist.June 3, 20213. TO THE CLERK: Consent to the above dismissal is hereby given.** REQUEST FOR DISMISSALForm Adopted for Mandatory Use Judicial Council of California CIV-110 [Rev. Jan. 1, 2013] Code of Civil Procedure, § 581 et seq.; Gov. Code, § 68637(c); Cal. Rules of Court, rule 3.1390 www.courts.ca.gov Page 1 of 2 TO THE CLERK: Please dismiss this action as follows: (1) (2)(1) (3) (4) (5) (6) (TYPE OR PRINT NAME OF (SIGNATURE) Attorney or party without attorney for: Plaintiff/Petitioner Defendant/Respondent Cross Complainant (SIGNATURE) ** If a cross-complaint - or Response (Family Law) seeking affirmative relief - is on file, the attorney for cross-complainant (respondent) must sign this consent if required by Code of Civil Procedure section 581 (i) or (j). *If dismissal requested is of specified parties only of specified causes of action only, or of specified cross-complaints only, so state and identify the parties, causes of action, or cross-complaints to be dismissed. (To be completed by clerk) 4. 5 6. 7. Clerk, by , Deputy 2. The court 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). a. (Complete in all cases except family law cases.) With prejudice Without prejudice Complaint Petition Cross-complaint filed by (name): on (date): Cross-complaint filed by (name): on (date): Entire action of all parties and all causes of action Other (specify):* did did not Date: ATTORNEY PARTY WITHOUT ATTORNEY) Dismissal entered as requested on (date): Dismissal entered on (date): as to only (name): Dismissal not entered as requested for the following reasons (specify): Attorney or party without attorney notified on (date): Attorney or party without attorney not notified. Filing party failed to provide a copy to be conformed means to return conformed copy Date: SUPERIOR COURT OF CALIFORNIA, COUNTY OF BRANCH NAME: CITY AND ZIP CODE: STREET ADDRESS: MAILING ADDRESS: Plaintiff/Petitioner: Defendant/Respondent: FOR COURT USE ONLY CASE NUMBER: REQUEST FOR DISMISSAL CIV-110 ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE: ZIP CODE:CITY: STREET ADDRESS: FIRM NAME: NAME: STATE BAR NO: TELEPHONE NO.: FAX NO. : E-MAIL ADDRESS: ATTORNEY FOR (Name): 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.) A conformed copy will not be returned by the clerk unless a method of return is provided with the document. a. b. 1. b. (2) (TYPE OR PRINT NAME OF Date: ATTORNEY PARTY WITHOUT ATTORNEY) Attorney or party without attorney for: Plaintiff/Petitioner Defendant/Respondent Cross Complainant ✘ ✘ ✘ ✘ John Cox ✘ San Francisco Civic Center Courthouse San Francisco, CA 94102 400 McAllister Street 400 McAllister Street Mitchell Champi Pacific Gas and Electric Co., et al. CGC-18-569951 CA 95401Santa Rosa 70 Stoney Point Road, Suite 70-A Law Offices of John Cox, P.C. John Cox 197687 707-241-4567 john.cox@jcoxlawfirm.com Plaintiff March 12, 2021 ELECTRONICALLY F I L E D Superior Court of California, County of San Francisco 03/16/2021 Clerk of the Court BY: YOLANDA TABO-RAMIREZ Deputy Clerk DISMISSAL ENTERED 03/16/2021 By: YOLANDA TABO-RAMIREZ Deputy Clerk Declaration Concerning Waived Court Fees 1. 3. The person named in item 1 is (check one below): a. b. c. REQUEST FOR DISMISSALCIV-110 [Rev. January 1, 2013] Page 2 of 2 I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. (TYPE OR PRINT NAME OF (SIGNATURE) 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.) The court waived court fees and costs in this action for (name): not recovering anything of value by this action. recovering less than $10,000 in value by this action. recovering $10,000 or more in value by this action. (If item 2c is checked, item 3 must be completed.) All court fees and court costs that were waived in this action have been paid to the court (check one): Yes No Date: ATTORNEY PARTY MAKING DECLARATION) CASE NUMBER:Plaintiff/Petitioner: Defendant/Respondent: CIV-110 2. CGC-18-569951Mitchell Champi Pacific Gas and Electric Co., et al. Print this form Save this form Clear this form For your protection and privacy, please press the Clear This Form button after you have printed the form.