Free Claim Form - California


File Size: 15.5 kB
Pages: 1
Date: June 15, 2009
File Format: PDF
State: California
Category: Court Forms - Local
Author: parrottr
Word Count: 146 Words, 1,306 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.mendocino.courts.ca.gov/forms/MMC-131.pdf

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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):

FAX NO. (Optional)

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO
ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: PETITIONER/PLAINTIFF: ___________________________________________ RESPONDENT/DEFENDANT: HEARING DATE: TIME: DEPT.:

CLAIM FORM
NAME AND ADDRESS OF VENDOR
_____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________________

Invoice No. _____________________
I hereby certify that the service and costs described in the attached invoice have been performed and incurred on the dates set forth and that no prior claim has been made for the same.

Signature of Claimant

CASE NAME: _______________________________ CASE NO. _____________

It is hereby ordered that the County of Mendocino, through the Auditor of the County, compensate the above named person for the total due for services rendered and costs incurred in the sum of $________________.

Dated: __________________ ___________________________ Judge of the Superior Court

MMC-131-local (rev 0609)