SC-100 to Go to Small Claims Court I Clerk S'f' a Ldatef~hen form is filed.

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Plaintiff's Claim and ORDER

----:-------------------------:--------------------------------------------------------------r,0 ANGELES SUPERIOR COURT NotIce to the person bemg sued:

You are the Defendant if your name is listed in (2) on page 2 of this form. The person suing you is the Plaintiff, listed in (1) on page 2.

You and the Plaintiff must go to court on the trial date listed below. If you do not go to court, you may lose the case.

If you lose, the court can order that your wages, money, or property be taken to pay this claim.

JUL 2 6 2010

• OHN)?~~~ CI,,~RK

A. NAZA~, DEPUTY

Bring witnesses, receipts, and any evidence you need to prove your case. Fill in court name and street address:

Read this form and all pages attached to understand the claim against you and to protect your rights.

Aviso al Demandando:

Usted es el Demandado si su nombre figura en (2) de la pagina 2 de este formulario. La persona que 10 demanda es el Demandante, la que figura en (1) de la pagina 2.

Usted y el Demandante tienen que presentarse en la corte en la fecha del juicio indicada a continuacion. Si no se presenta, puede perder el caso. .

Si pierde el caso la corte pod ria ordenar que Ie quiten de su sueldo, dinero u otros bienes para pagar este reclamo.

Superior Court of California. County of Los Angeles: NORTHWEST DISTRICT (-19498- )

VAN NUYS COURTHOUSE EAST

6230 SYLMAR A VENUE

VAN NUYS. CA. 91401

(818) 374-2901

Clerk fills in case number and case name:

Case Number: LA V 10V04833

Case Name: HATAT, HELEN VS ZUPAN, MARY

Lleve testigos, recibos y cualquier otra prueba que necesite para probar sucaso.

Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos.

Order to Go to Court The people in (1) and (2) must go to court: (Clerk fills out section below.) =====================================================

TRIAL DATE

DATE 09/23/2010

TIME 01 :30 PM

DEPARTMENT NWZ

LOCATION ROOM 320, THIRD FL

===================================================== Date: 07/26/2010 JOHN A. CLARKE, Executive Officer/Clerk

By ANNA NAZARY AN , Deputy Instructions for the person suing:

You are the Plaintiff. The person you are suing is the Defendant.

Before you fill out this form, read Form SC-150, Information for the Plaintiff (Small Claims), to know your rights. Get SC-150 at any courthouse or county law library, or go to: www.courtinfo.ca.govlforms

Fill out pages 2 and 3 of this form. Then make copies of a" pages of this form. (Make 1 copy for each party named in this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk's office and pay the filing fee. The clerk will write the date of your trial in the box above.

You must have someone at least 18--not you or anyone else listed in this case--give each Defendant a court­stamped copy of all 5 pages of this form and any pages this form tells you to attach. There are special rules for "serving," or delivering, this form to public entities, associations, and some businesses. See Forms SC-104, SC-104B, and SC-104C.

Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case.

Judicial Council of California, www.courtinfo.ca.gov

Revised January 1, 2008, Mandatory Form

Code of Civil Procedure, 116.110 et seq.,

116.220(c), 116.340(9)

Plaintiff's Claim and ORDER to Go to Small Claims Court

(Small Claims)

SC-100, Page 1 of 5

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SC-100 Plaintiff's Claim and ORDER to Go to Small Claims Court

Clerk stamps date here when form is filed.

Notice to the person being sued:

• You are the Defendant if your name is listed in @ o~age 2 ofthis form. The person suing you is the Plaintiff, listed in (j) on page 2.

-PD ~ FIL~ . LOS ANGELES SUPERIOR COl Rl

• You and the Plaintiff must go to court on the trial date listed below. If you do not go to court, you may lose the case.

• If you lose, the court can order that your wages, money, or property be taken to pay this claim.

• Bring witnesses, receipts, and any evidence you need to prove your case.

• Read this form and all pages attached to understand the claim against you and to protect your rights.

Aviso al Demandado:

• Usted es el Demandado si su nombre figura en@ de la pagina 2 de este formulario. La persona que 10 demanda es el Demandante, la que

figura en CD de la pagina 2.

• Usted y el Demandante tienen que presentarse en la corte en la fecha del juicio indicada a continuaci6n. Si no se presenta, puede perder el caso. .

• Si pierde el caso la corte podria ordenar que Ie quiten de su sueldo, dinero u otros bienes para pagar este reclamo.

JUL 2 8 ~u1O

JOHN A:t2. .. ~ i'R :~;GL.ERK .", /~'/ f)'( A. NAlI\, .' '; DEPUTY

Fill in court name and street address: Superior Court of California, County of

OS ANGELES ~.UPER'OR COU OATHWEST DISTRICT. EAST B 23? ~YLMAR AVENUE, ROOM

. NUYS. CA 91401 Clerk fills in case number and case name:

• Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso.

• Lea este formulario y todas las paginas ad juntas para entender la demanda en su contra y para proteger sus derechos.

Order to Go to Court

The people in CD and ® must go to court: (Clerkfil ',' ".... ~/Ilw "" Trial )+ Date

Date 1. 9/2 J. Department N!~~iiId!k'dCfiSss Ei1I!Sai!i\1j (fi:1if~lA.tJ[froo rtl'&WtG

(S:2:3G $'1LMAR AVENUE, ROOM

2. ________________________________________ ~-------.~----------------

3. _________________________ -------------~~~~--+---"~nrTTr=~~=_~

Date: JUL 2 6 lOtft ClerkJQtfN A. CLAR Instructions for the person suing: • You are the Plaintiff. The person you are suing is the Defendant.

• Before you fill out this form, read Form SC-150, Informationfor the Plaintiff (Small Claims), to know your rights. Get SC-150 at any courthouse or county law library, or go to: www.courtinfo.ca.govlforms

• Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Make 1 copy for each party named in this case and an extra copy for yourself.) Take or mail the original and these copies to the court clerk's office and pay the filing fee. The clerk will write the date of your trial in the box above.

• You must have someone at least IS-not you or anyone else listed in this case-give each Defendant a court-stamped copy of all 5 pages of this form and any pages this form tells you to attach. There are special rules for "serving," or delivering, this form to public entities, associations, and some businesses. See Forms SC-104, SC-I04B, and SC-I04C.

• Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you need to prove your case.

Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2008, Mandatory Form Code of Civil Procedure, §§ 116.110 et seq., 116.220(c), 116.340(9)

Plaintiff's Claim and ORDER to Go to Small Claims Court

(Small Claims)

SC·100, Page 1 of 5 -+

American LegalNet, Inc. www.FormsWorkflow.com

lDING

Plaintiff (list names):

I Case Numb."

CD The Plaintiff ~he person, business, or public entity that is suing) is: Name: HCl t? rv= N AW:C Street address: 154;) f ~fl) &MooK" q{QO.Je. l:1&ela

Street City

Mailing address (if different): Po G>o"i 31 CJO 4 L, ~ lh Street City

If more than one Plaintiff, list next Plaintiff here: Name: --------------------------------- Phone: (_--L-__ __

Street address: ~------------------__::c,__---------~------..,___-----Street City State Zip

Mailing address (if different):~___:_--------------___::_:_:__-----_::_:_,__---_::_:_---Street City State Zip

o Check here ifmore than 2 Plaintiffs and attach Form SC-JOOA.

o Check here if either Plaintiff listed above is doing business under a fictitious name. If so, attach Form SC-J 03.

o The Defendant (the person, business, or public entity being sued)" is:(} Name: \CIAR't UJ Qf:lru/ Phone: 01~) 1o.2r ILI73 Street address: 7rbt53 &1bo.~c~k A"\\-e · ft: \ t(;~ Id~l ~/ CA z/'6 Q S

Mailing address (if different): -=---:------------------=:-:---------=-c------=-----Street City State Zip

If more than one Defendant, list next Defendant here: Name: c... A. G\, ~ Phone:(3)g)QS2 l~ 73 Street address:1453 S{b~, Je (t.d. Y \ cff1'\kf. Ho:RD!;i{ l rnnJ ) en 0/) be 'S

S~et ~ tt' City r Stater Zip

Mailing address (if different): -=---:-______________ -:-::-_______ ---::"....,.. ___ --:::-:--___ _ Street City State Zip

o Check here ifmore than 2 Defendants and attach Form SC-JOOA.

o Check here if any Defendant is on active military duty, and write his or her name here: _________ _

o The Plaintiff claims the Defendant owes $ _ f 500. \P \

,Explain below): CerYv..J-e.J~ a. Why does the Defendant owe the Plaintiff money?_~ ......... _4J__";IIpu_.l..I",;I'''"'''''"~f_'__''''i''l~:::..cpo-..£.f.#_:_LU~ ....... CL..:-.L..LJor-1

~ ~ T

h. When did this happen? (Date): V1o,l cD.-. 1 c,. ,r:le> I <.?

If no specific date, give the time period: Date started: Through: _-'eu/l'-" .... ~"""""""-'<.:::r----c. How did you calculate the money owed to you? (Do not include court costs or fees for service.) F\L CE:J5 (L.-1..L ,

. .fKI Check here if you need more space. Attach one sheet 0 paper

the top. () 1\ J'b r~(:YI(J..I.)L~~ ~

Revised January 1. 2008 Plaintiff's Claim and ORO to Go to Small Claims Court

(Small Claims)

SC-100, Page 2 of 5 ~

SC-104 Proof of Service

Use this fonn to serve a person, a business, or a public entity. To learn mortLo about proof of service, read What Is "Proof of Service"?, Fonn SC-I04B. To learn more about how to serve a business or entity, read How to Serve a Business or Public Entity, Fonn SC-I04C. To serve a business, you must serve one of the following people: • Owner (for a sole proprietorship) • Partner (for a partnership) or general partner (for a limited partnership)

• Any officer or general manager (corporation or association) • Any person authorized for service by the business (corporation, association,

general partnership, limited partnership) • Any person authorized for service with the Secretary of State (corporation,

association, limited liability company [LLC], limited liability partnership [LLP], limited partnership)

To serve a public entity, you must first file a claim with that entity, then serve one of the following people: • Clerk (of a city or county) • Chief officer or director (of a public agency) • Any person authorized for service by the entity G) a. If you are serving a person, write the person's name below:

,.J\fary Zupan

~. If you are serving a business or entity, write the name of the business or entity, the person authorized ror service, and that person's job title:

Person .A~uthorized for Service Job Tide

Instructions to Server:

t '/ i '(>1 Jv l L-

(;Jerk stamps.d. ate h~. ". form is filed.

I:' 11 If I : lJ' . ' ~' • ..JjL.J .' 'OURT

ANGELES SUPERIOR C

I St.'? 1 ';1

Fill in court name and street address:

Superior Court of California, County of

Los Angeles Northwest District Van Nuys Courthouse East 6230 Sylmar Ave. Van Nuys, CA 91401 Fill in case number, case name, hearing date, day, time, and department below:

I Case Number:

LA V 10V04833

Case Name:

Halat vs Zupan

I Hearing Date: Nov J st 20 lO

rime: 8:30 Ai'if IDept: NW K

YuuiUu:;i be at ka:;l ] g ytalS old ana nut ue nameu ill this CHM'. Follow these steps:

• Give a copy of all the documents checked in @ to the person in CD, or §~~'

• Give a copy of all the documents checked in@ to one of the following people: ~~ ••. a. A competent adult (at least 18) living with, and at the home of the person in CD, or ~""~ b. An adult (at least 18) who seems to be in charge at the usual workplace of the person in ~~or c. An adult (at least 18) who seems to be in charge where the person in CDusually receives ~d

(but not a U.S. Post Office box), if there is no known physical address for the person inCD' and mail a copy of the documents left with one of the adults in a, b, or c above to the person i~. ~',.;

THEN :':'1.. r'

• Complete and sign this fonn, and .. ~' ,_, • Give or mail your completed fonn to the person who asked you to serve these court papers, in t{t'{le for

the form to be flied with the court at least 5 days before the hearing. \l;

I served the person in CD a copy of the documents checked below: a ~ii Cl a. [2] SC-IOO, Plaintiffs Claim and ORDER to Go to Small Claims Court -I.'. ( :l b. D SC-120, Defendant'S Claim and ORDER to Go to Small Claims Court ~ c. D Order for examination (This form must be personally served. Check the form that was served):

Note: The court can issue a civil arrest warrant if the served party does not come to court only if the order for examination was personally served by a registered process server, sheriff, marshal, or someone appointed by the court.

(1) D SC-134, Application and Order to Produce Statement of Assets and to Appearfor Examination

(2) D AT-138/EJ-12S,App/ication and Order for Appearance and Examination

d. D Other (specifY): Judicial Council of California, www.cou/tinfo.ca.gov Revised January 1, 2009, Optional Fonn Code of Civil Procedure, §§ 116.340. 415.10, 415.20

Proof of Service (Small Claims)

SC-104, Page 1 of 2 -+

Plaintiff (list names):

o You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue. Have you done this? ~Yes 0 No Ifno, explain why not: ______________________________ _

CD Why are you filing your claim at this courthouse? This courthouse covers the area (check the one that applies): a. ~ (1) Where the Defendant lives or does business. (4) Where a contract (written or spoken) was made,

(2) Where the Plaintiffs property was damaged. signed, performed, or broken by the Defendant or (3) Where the Plaintiff was injured. where the Defendant lived or did business when

the Defendant made the contract.

b.D Where the buyer or lessee signed the contract lives now, or lived when the contract was made, if this claim is about an offer or contract for personal, family, or household goods, services, or loans. (Code Civ.

Proc., § 395(b).)

c. 0 Where the buyer signed the contract, lives now, or lived when the contract was m8.de, if this claim is about a retail installment contract (like a credit card). (Civil Code, § 1812.10.)

d. 0 Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle is permanently garaged, if this claim is about a vehicle fmance sale. (Civil Code, § 2984.4.)

e. 0 Other (specify): ___________________________ _

o List the zip code of the place checked in ® above (if you know):_O{++(-",;LJOu.~~---__

o Is your claim about an attorney-client fee dispute? 0 Yes ~ No If yes, and if you have had arbitration, fill out Form SC-1 01, attach it to this form, and check here: D

CD Are you suing a public entity? 0 Yes !Xl No If yes, you must file a written claim with the entity first. 0 A claim was filed on (date): ________ _ If the public entity denies your claim or does not answer within the time allowed by law, you can file this form.

e!) Have you filed more tha~ 12 other.small ~Iaim~ within the last 12 months in California? DYes ®. No If yes, thefilmgfeefor thzs case wzll be hzgher. .

@ I understand that by filing a claim In small claims court, I have no right to appeal this claim.

@ 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.

I declare, under penalty of perjury under California State law, that the information above and on any attachments to this form is true and correct. ~ It /' Date:j/a'f/o. AIf1, tJeJ&In HA-~

, , Plaintiff types Plaintiff signs here

Date: ..t.:~,----.--:--=--...,...-------Second Plaintiff types or prints name here Second Plaintiffsigns here

,< Requests for Accommodations Assistive listening systems, computer-assisted, real-time captioning, or sign language interpreter services are available if you ask at least 5 days before the trial. Contact the clerk's office for Form MC-410, Requestfor Accommodations by Persons With Disabilities and Response. (Civil Code, § 54.8.)

Revised January 1. 2008 Plaintiff's Claim and ORDER to Go to Small Claims Court

(Small Claims)

SC·100, Page 3 of 5

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