Free 13 CIV-110 v.8 03.11.09 CLEAN.o - California

CIV-110
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
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT:

REQUEST FOR DISMISSAL Personal Injury, Property Damage, or Wrongful Death Other Motor Vehicle Family Law Eminent Domain Other (specify) :

CASE NUMBER:

- A conformed copy will not be returned by the clerk unless a method of return is provided with the document. 1. TO THE CLERK: Please dismiss this action as follows: a. (1) With prejudice (2) Without prejudice b. (1) (3) (4) (5) (6) Complaint (2) Petition Cross-complaint filed by (name): Cross-complaint filed by (name): Entire action of all parties and all causes of action Other (specify):* on (date): on (date):

2. (Complete in all cases except family law cases.) Court fees and costs were waived for a party in this case. (This information may be obtained from the clerk. If this box is checked, the declaration on the back of this form must be completed). Date:

..........................................
(TYPE OR PRINT NAME OF ATTORNEY PARTY WITHOUT ATTORNEY) (SIGNATURE)

*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.

Attorney or party without attorney for: Plaintiff/Petitioner Defendant/Respondent Cross Complainant

3. TO THE CLERK: Consent to the above dismissal is hereby given.** Date:
(SIGNATURE)

(TYPE OR PRINT NAME OF

ATTORNEY

PARTY WITHOUT ATTORNEY)

** 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).

Attorney or party without attorney for: Plaintiff/Petitioner Cross Complainant Defendant/Respondent

(To be completed by clerk) Dismissal entered as requested on (date): 4. Dismissal entered on (date): as to only (name): 5 Dismissal not entered as requested for the following reasons (specify): 6. 7. a. b. Date:
Form Adopted for Mandatory Use Judicial Council of California CIV-110 [Rev. July 1, 2009]

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 Clerk, by , Deputy
Page 1 of 2 Code of Civil Procedure, § 581 et seq.; Gov. Code, § 68637(c); Cal. Rules of Court, rule 3.1390 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com

REQUEST FOR DISMISSAL

CIV-110 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER:

Declaration Concerning Waived Court Fees
The court has a statutory lien for waived fees and costs on any recovery of $10,000 or more in value by settlement, compromise, arbitration award, mediation settlement, or other recovery. The court's lien must be paid before the court will dismiss the case.

1. The court waived fees and costs in this action for (name): 2. The person in item 1 (check one): a. is not recovering anything of value by this action. b. is recovering less than $10,000 in value by this action. c. is recovering $10,000 or more in value by this action. (If item 2c is checked, item 3 must be completed.) 3. All court fees and costs that were waived in this action have been paid to the court (check one): Yes No

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date:

(TYPE OR PRINT NAME OF

ATTORNEY

PARTY MAKING DECLARATION)

(SIGNATURE)

CIV-110 [Rev. July 1, 2009]

REQUEST FOR DISMISSAL

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