California > Local County > Los Angeles > Civil
Government Claim-Judicial Branch - California
| Government Claim-Judicial Branch Form. This is a California form and can be used in Civil Los Angeles Local County . |
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COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Plaintiff(s) -against: : : : Index No. FOR COURT OR OFFICIAL USE ONLY FOR COURT OR OFFICIAL USE ONLY Calendar No. JUDICIAL SUBPOENA [DATE STAMP] Postmark date if received byby mail: _________ Postmark date if received mail: ___________ GOVERNMENT. CLAIM--JUDICIAL .BRANCH . . . . . .: ............. ...................... ........... (Government Code section 910.4) Defendant(s) THE PEOPLE OF THE STATE OF NEW YORK Name of Claimant TO Mailing Address CLAIMANT Home Telephone City State Work Telephone Zip Code Send notices regarding this claim to (if different from above): NameGREETINGS: Mailing Address COMMAND YOU, that all businessCity excuses being laid aside, you and each of Code State Zip you attend before WE and , the Honorable at the Court located at County of CLAIM INFORMATION o'clock in the in room , on the day of , 20 , at noon, and at any recessed Date of Incident (Month/Day/Year) give evidence as a witness in this action on the part Incident Time of of the or adjourned date, to testify and Location of Incident Your failure to comply with this subpoena is punishable as a as a result of the incident. Describe the indebtedness, obligation, injury, damage, or loss incurredcontempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 State the circumstances that gave rise to this claim. (State the facts that support your claim and why you (Attorney must sign above and or name below) believe the court or another judicial branch entity is responsible for the alleged damagetype injury.) If known, provide the name of the official or employee who allegedly caused the injury, damage, or loss (if there is more than one official or employee, name each). If you need more space, please attach additional sheets of paper. Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: GOVERNMENT CLAIM--JUDICIAL BRANCH PAGE 1 of 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Name of Claimant: ____________________________ : Calendar No. : If the total amount of your claim is up to $10,000: JUDICIAL more than $10,000, Plaintiff(s)If the amount of your claim is SUBPOENA indicate whether your claim would be a limited civil -against: Amount of damages as of this date: case or an unlimited civil case (check one): Estimated amount of future damages: : Total amount claimed: Limited civil (amount is $25,000 or less) Unlimited civil (amount is more than $25,000) : State how the amount of your claim was computed (include copies of supporting documentation such as billing : statements,. invoices, receipts, . . . . estimates). .Defendant(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . and . . . . . . . . . . . . . . . . . . . . THE PEOPLE OF THE STATE OF NEW YORK TO List the names, addresses, and telephone numbers of all witnesses to the incident. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Provide any additional information that might be helpful in considering this claim. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Nameresult of your failure to comply. of Authorized Representative Mailing Address Witness, Honorable REPRESENTATIVE (Complete only ifwas issuedpresented by someone acting on claimant's behalf)as a the party on whose behalf this subpoena claim is for a maximum penalty of $50 and all damages sustained Telephone City State the , one of the Justices of Zip Code Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Court in County, day of , 20 PLEASE NOTE: Presentation of a false claim with intent to defraud is a criminal offense (Penal Code section 72). (Attorney must sign above and type name below) Signature of Claimant or Authorized Representative (check one) for Attorney(s) Date Deliver or mail this claim form to: Attention: Court Executive Officer (Claims) Superior Court of California, County of Los Angeles Stanley Mosk Courthouse 111 North Hill Street, Room 105E Los Angeles, CA 90012 Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: GOVERNMENT CLAIM--JUDICIAL BRANCH Mobile Tel. No.: PAGE 2 OF 2 American LegalNet, Inc. www.USCourtForms.com
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