arrow left
arrow right
  • RODRICK BRECKLER et al VS. ASBESTOS DEFENDANTS (B*P) AS REFLECTED ON et al ASBESTOS document preview
  • RODRICK BRECKLER et al VS. ASBESTOS DEFENDANTS (B*P) AS REFLECTED ON et al ASBESTOS document preview 
						
                                
Preview

                                Clv-050

~ DO NOT FILE WITH THE COURT —
_ UNLESS YOU ARE APPLYING FOR A DEFAULT JUDGMENT UNDER CODE OF CIVIL PROCEDURE § 585 --

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address). TELEPHONE NO.

DAVID R. DONADIO, ESQ. (Bar # 154436) (415) 898-1555 ELECTRONICALLY
BRAYTON**PURCELL LLP FAX NO

222 Rush Landing Road (415) 898-1247 FILED

Novato, California 94948-6169
ATTORNEY FOR (aeney: Plaintiff(s)

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO
steer avoress, 400 McAllister Street

MAILING ADDRESS:

Superior Court of California,
County of San Francisco

OCT 28 2009
GORDON PARK-LI, Cler|
BY: RAYMUNDA MABAET

aryanpze cone: San Francisco 94102 Deputy Clerk
BRANCH NAME:
piaintiFe, RODRICK BRECKLER and JOANN BRECKLER
| perenvant; ASBESTOS DEFENDANTS (B%P)
CASE NUMBER:
STATEMENT OF DAMAGES men 274566
. (Personal injury or Wrongful Death)
To (name of one defendant only}: CARL N. SWENSON CO, INC
Plaintiff (name of one plaintiff only}: JOANN BRECKLER
seeks damages in the above-entitied action, as follows:
1. General damages AMOUNT
a oO Pain, suffering, and inconvenience 0.2.2.0 eee tenes $
b. Oo Emotional distress $ ae
cD Loss of consortium $ __ 250,000.00
d. oO Loss of society and campanionship(wrongful death actions only}... 2... ee ee $
e oO Other (specify) 6... en ee tees $e
t O Other (specify) 0 eee een eee $
g. oO Continued on Attachment 1.9.
2. Special damages
a. Oo Medical expenses (to date) 6... cee ete tenet tenet been ee cee eee $
b. Oo Future medical expenses (present value)... eee eee $
c. Oo Loss of earnings (to date) .......----..-2-2-5 $
d. o Loss of future earning capacity (present value) $
e. Oo Property damage $
Oo Funeral expenses (wrongful death actions only) 60.0 eee eee $
g O Future contributions (present value) (wrongful death actions only)... 2... eee $
h. O Value of personal service, advice, or training (wrongful death actions only)... 2.0.0... eee $
i oO Cther (specify) $
ji. oO Other (specify) $
«. C1 continued on Attachment 2k.
3. i Punitive damages: Plaintiff reserves the right to seek punitive darnages in the amount of (specify)...... $ _§,000,000.00
when pursuing a judgment in the suit filed against you.
Date:
OCT 28 zag GOom
____David R, Donadig >
(TYPE OR PRINT NAME) (SIGNATURE OF PLAINTIFF OR ATTORNEY FOR PLAINTIFF]
(Proof of service on reverse)
Form Adopted for Mandatory Use STATEMENT OF DAMAGES. Code of Civil Procedure, §§ 426.14, 426.118
“Judicial Counell af Cahtornia ‘se courtinfo ca.gov
CIV-050 [Rev. January 1, 2007] (Personal Injury or Wrongful Death)

LexisNexis® Automated California Judicial Council Forms