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Declaration In Support Of Plaintiffs Claim - California
| Declaration In Support Of Plaintiffs Claim Form. This is a California form and can be used in Civil Kings Local County . |
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1 2 3 4 5 Plaintiff, 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3. 1. vs. SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF KINGS No. __________________ ____________________________, DECLARATION IN SUPPORT OF PLAINTIFF'S CLAIM [CCP §116.540(f)] ____________________________, Defendant(s). I am the Plaintiff in this small claims matter and am currently incarcerated in a county jail, a Department of Corrections facility, or a Youth Authority facility. 2. I request damages (exclusive of fees and costs) be awarded in my favor and against Defendant(s), as follows: Name of Defendant: ___________________________ ___________________________ ___________________________ Amount of Damages: _____________________ _____________________ _____________________ I also request an award of costs (filing fees and service costs) against the Defendant(s) in the amount of $____________. 4. 5. The alleged breach of duty or contract occurred on _______________. The facts supporting my claim for damages are as follows:______________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ __________________________________________________ (additional pages attached? Y or N [circle one]. Label Additional Page(s) as "Facts in Support of Claim".) DECLARATION IN SUPPORT OF PLAINTIFF'S CLAIM Kings County Superior Court Local Rule 403(E) [CCP §116.540(f)] American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 6. I [have] or [have not] (circle one), attached documents in support of my claim. Identify name and relevance of any document attached to Declaration. Name of Document: ___________________________(Exh. 6(A)) Relevance to Claim: _____________________ _____________________ ___________________________(Exh. 6(B)) _____________________ _____________________ ___________________________(Exh. 6(C)) _____________________ _____________________ ___________________________(Exh. 6(D)) _____________________ _____________________ ___________________________(Exh. 6(F)) _____________________ _____________________ (additional pages attached? Y or N [circle one]. Label Exhibits as Exhibit 6(G) through 6(Z) as appropriate.) 7. Prior to filing this Declaration, I [did] or [did not] (circle one) make a demand for payment to the Defendant(s). If I did not make a demand for payment to one or more of the Defendants, the reason I did not do so is:_________________________________ ________________________________________________________________________ ________________________________________________________________________ _____________________________________________________________________ 8. Prior to filing this Declaration, I [did] or [did not] (circle one) exhaust all available administrative remedies against the Defendant(s). (Mark one) [ ] A Director's Level Response to my administrative appeal pursuant to California Code of Regulations, title 15, Section 3084.1, et. seq., was received on: _______ (date) [ ] I have not received a Director's Level Response to my administrative appeal because:_________________________________________________________________ ________________________________________________________________________ _____________________________________________________________________ DECLARATION IN SUPPORT OF PLAINTIFF'S CLAIM Kings County Superior Court Local Rule 403(E) [CCP §116.540(f)] Page 2 American LegalNet, Inc. www.FormsWorkFlow.com 1 9. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The regularly sitting temporary judges of the Kings County Superior Court are Manuel Vierra, Esq. and Valerie Chrissakis, Esq. Either of these individuals may be assigned to hear your case. DECLARATION IN SUPPORT OF PLAINTIFF'S CLAIM Kings County Superior Court Local Rule 403(E) [CCP §116.540(f)] Page 3 American LegalNet, Inc. www.FormsWorkFlow.com Prior to filing this Declaration, I [did] or [did not] (circle one) file a claim with the California Victim Compensation and Government Claims Board ("VCGCB"). (Mark one) [ ] My claim was denied on ___________ (date) [ ] I did not file a claim with the VCGCB because:__________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________________________________________________________ 10. I hereby consent to the court's appointment of a temporary judge to hear this matter. I understand that a temporary judge is a qualified member of the State Bar and that I have a right to have the matter heard before a judge, commissioner, or referee of the court. 1 11. I declare under penalty of perjury under the laws of the State of California that the foregoing, and all matters stated in the attached pages hereto are true and correct to the best of my personal knowledge. As to those matters stated on information and belief, I believe the same to be true and correct. This Declaration in Support of Plaintiff's Claim was executed by me on ______________, 20____ at __________________________ (identify address where executed). ___________________________ Print Name of Declarant _________________________ Signature of Declarant NOTICE: This Declaration must be filed with the court at least 5 court days prior to the hearing scheduled in your small claims case. Unless good cause has been shown to exist, a copy of this Declaration and all attachments must be served upon the Defendant(s) prior to the hearing. 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Executed on STATE OF CALIFORNIA ) ) COUNTY OF KINGS ) PROOF OF SERVICE BY MAIL *** ss. No. _________________ I hereby declare under penalty of perjury that I am over the age of eighteen (18) years and not a party to this action. I further declare under penalty of perjury that on , 200 , and in accordance with the procedures for the mailing of documents employed by ___________________________ (prison name), I served the attached DECLARATION IN SUPPORT OF PLAINTIFF'S CLAIM via first class mail by depositing a true copy thereof, enclosed in a sealed envelope with postage fu
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