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Plaintiff's Clalm and ORDER Clerk stamps date here when formis filed.
SC'1 00
to Go to Small Claims Court
' '
Netlce to the person being sugd. : F i LE fl
SUPERlOR QOURT 0F QALSFORNM
'
You are the defendant 1f your name ls 11sted
-
1n
® 0n page 2 0f thls form or
-
‘OOUNW 9,: 3AM BgRNARDWQ
on form SC-lOOA. The person suing you
on page
is the plaintiff, listed in
@
2.
MAY 1 0 202‘?
‘
You and the plaintift‘must go to court on the trial date listed below. Ifyou
do not go to court, you may lose the case. Ifyou lose, the court can order
that your wages, money, or property be taken pay this claim.
to
Deui
BY: ,Palindo.
'
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 t0 understand the claim against you
Superior Court of California, County of
and to protect your rights.
Aviso al Demandado: Superior Court, San Bernardino
® 17730 ANCOAw Boulevard
- r -
°
Usted es e1 Demandado su nombre figura en
31 d6 13 paglna 2 d6 este
formulario, o en e1 formulario SC-lOOA. La persona que lo demanda es el F0” anal 92335
. _
Demandante, [a que flgura en Fontana Dlstrlct
G) de la paging 2_
°
Usted y el Demandante tienen que presentarse en la come en 1a fecha del Com fills m case number when form is med
juicio indicada a continuacién. Si no se presenta, puede perder el caso. Si
Case; : I
I
pierde el caso, la corte podria ordenar que le quiten de su sueldo, dinero u gtrvx .2 4U 1 5 CE 1
otros bienes para pagar este reclamo.
~
Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso case Namezm mUfl V9 -
.
Lea este formulario y todas
en su contra y para proteger sus derechos.
las péginas adjuntas para entender 1a demanda
M EE I SET
53
The people
l
Trial
Date
-->
I'm
2.
3'
Dane:
in
Date
(D and
MAY 1
mfl
® must attend court:
Time
mu
Department
Clerk, by
(Clerkfills outsecu‘on below.)
Name and
1-) 4 A
address 0f court, if different from above
I
, Deputy
Instructions for the person suing:
Do not use this form to recover COVID-19 rental debt, which is unpaid rent or other financial obligations under a
tenancy due between March 1, 2020, and September 30, 2021. (See Code of Civil Procedure, §1 179.02.) To recover
COVID-19 rental debt, use form SC—SOO. Plaintiff’s Claim and ORDER t0 Go t0 Small Claims Court.
o You are the plaintiff. The person you are suing is the defendant.
o Before you fill out this form, read form SC—lOO-INFO. Information for the Plaintiffl to know your rights. You can get
form SC-lOO-INFO at any courthouse or county law library, or go to www.courts‘ca.gov/t'orms.
'
Fill out pages 2, 3, and 4 of this form. Make copies of all the pages of this form and any attachments—one for each
party named case and an extra copy for yourself. Take or mail the original and the copies t0 the court clerk’s
in this
office and pay the filing fee. The clerk will write the date of your tn'al in the box above. Your court may allow
electronic filing. Check your local court website for information: www.courtsx'a‘go v/find—n1v-court.htm.
c You must have someone 18—not you or anyone else listed in this case—give each defendant a court-stamped
at least
copy ofall pages of this form and any pages this form tells you to attach. There are special rules for “serving,” 0r
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.
JudicialCouncilofCalifornia,www.courrs.ca.gov
Rev. November 1, 2021, Mandatory Form
Plaintiff's Claim and ORDER SC-100, Page 1 Of6
CodeofCivilProcedure,§§116.110etseq.,
116.220(c), 116.340(g)
to Go to Small Claims COUrt .9
Plaintiff (list names) Metm %‘ mon-b Case Number:
5 C V A Z40 1 53 1
7
® The
Name:
plaintiff (the
Dcrri CL
person, business, or public entity that
R nymowj
is suing)
Phone:
is:
95! -
‘f 90'§802
Street address: 7D b 8 5V CAMOI’C A lie # /08 MDHfC/elf Cl" 9 / 76 3
Street City State Zip
Mailing address ('z'fdg'fferent):
Street City State Zip
Email address (ifavailable): Pa’ym onoL q (Q mgr, . Com
If more than one plaintiff, list next plaintiff here:
Name: Phone:
Street address:
Street City State Zip
Mailing address ((fdiffel'ent):
Street City State Zip
Email address (ifavailable):
D Check here ifmore than two plaintiff? and attachfbrm SC-IOOA.
D Check here ifez'therplaintifflisted above
”
is doing business under a fictitious name and attachfor'm SC—I 03.
"
D Check here zfany plaintiffis a “licensee 0r “deferred deposit originator (payday lender) under Financial
Code sectians 23000 et seq.
® The defendant
Name: weskrfi
(the person, business, or public entity being suedJeifi-"J
[Vefioné‘ PI’DPer‘H'e; DKA Wfimfljmpfl
4‘
hale:
ena
qt] 4). goz .
(92 ao
Street address: 8 i XL CV? ‘VQ Cf-"C‘Z TTVMQ C» QZb/L/
Street City State Zip
Mailing address ({fdifferent):
Street City State Zip
Ifthe defendant is a corporation, limited liability company, or public entity, list the person
~
or a ent authorized for service of p rocess here:
Nam: CY” "H" i? \31‘4
l‘+
Job title, ifknown: Mgm—bzm (w
Address; 8 Ewcufim Cmcie irvme C’A qzu: IL/
Street City State Zip
D Check here if'your case is against more than one defendant and attachfbrm SC-100A.
D Check here z'fany defendant 1's
0n active military duty and write defendant ’S name here:
The plaintiff claims the defendant $ )2 5‘00 owes (Explain below and on nextpage.)
[
.
(Note: A claimfor CO VID—19 rental debt cannot be made 0n thisform. Useform
SC—SOO. Plaintiff’s Claim and ORDER to Go to Small Claims Court (COVlD-19 Rental Debt),)
a. Why does the defendant owe the plaintiff money?
0V8 F pm D Rem +
ReV-Novembe'1-20“ Plaintiff’s Claim and ORDER to Go to Small Claims Court $0100, P6962 °f6
._>
Preview
Plaintiff's Clalm and ORDER Clerk stamps date here when formis filed. SC'1 00 to Go to Small Claims Court ' ' Netlce to the person being sugd. : F i LE fl SUPERlOR QOURT 0F QALSFORNM ' You are the defendant 1f your name ls 11sted - 1n ® 0n page 2 0f thls form or - ‘OOUNW 9,: 3AM BgRNARDWQ on form SC-lOOA. The person suing you on page is the plaintiff, listed in @ 2. MAY 1 0 202‘? ‘ You and the plaintift‘must go to court on the trial date listed below. Ifyou do not go to court, you may lose the case. Ifyou lose, the court can order that your wages, money, or property be taken pay this claim. to Deui BY: ,Palindo. ' 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 t0 understand the claim against you Superior Court of California, County of and to protect your rights. Aviso al Demandado: Superior Court, San Bernardino ® 17730 ANCOAw Boulevard - r - ° Usted es e1 Demandado su nombre figura en 31 d6 13 paglna 2 d6 este formulario, o en e1 formulario SC-lOOA. La persona que lo demanda es el F0” anal 92335 . _ Demandante, [a que flgura en Fontana Dlstrlct G) de la paging 2_ ° Usted y el Demandante tienen que presentarse en la come en 1a fecha del Com fills m case number when form is med juicio indicada a continuacién. Si no se presenta, puede perder el caso. Si Case; : I I pierde el caso, la corte podria ordenar que le quiten de su sueldo, dinero u gtrvx .2 4U 1 5 CE 1 otros bienes para pagar este reclamo. ~ Lleve testigos, recibos y cualquier otra prueba que necesite para probar su caso case Namezm mUfl V9 - . Lea este formulario y todas en su contra y para proteger sus derechos. las péginas adjuntas para entender 1a demanda M EE I SET 53 The people l Trial Date --> I'm 2. 3' Dane: in Date (D and MAY 1 mfl ® must attend court: Time mu Department Clerk, by (Clerkfills outsecu‘on below.) Name and 1-) 4 A address 0f court, if different from above I , Deputy Instructions for the person suing: Do not use this form to recover COVID-19 rental debt, which is unpaid rent or other financial obligations under a tenancy due between March 1, 2020, and September 30, 2021. (See Code of Civil Procedure, §1 179.02.) To recover COVID-19 rental debt, use form SC—SOO. Plaintiff’s Claim and ORDER t0 Go t0 Small Claims Court. o You are the plaintiff. The person you are suing is the defendant. o Before you fill out this form, read form SC—lOO-INFO. Information for the Plaintiffl to know your rights. You can get form SC-lOO-INFO at any courthouse or county law library, or go to www.courts‘ca.gov/t'orms. ' Fill out pages 2, 3, and 4 of this form. Make copies of all the pages of this form and any attachments—one for each party named case and an extra copy for yourself. Take or mail the original and the copies t0 the court clerk’s in this office and pay the filing fee. The clerk will write the date of your tn'al in the box above. Your court may allow electronic filing. Check your local court website for information: www.courtsx'a‘go v/find—n1v-court.htm. c You must have someone 18—not you or anyone else listed in this case—give each defendant a court-stamped at least copy ofall pages of this form and any pages this form tells you to attach. There are special rules for “serving,” 0r 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. JudicialCouncilofCalifornia,www.courrs.ca.gov Rev. November 1, 2021, Mandatory Form Plaintiff's Claim and ORDER SC-100, Page 1 Of6 CodeofCivilProcedure,§§116.110etseq., 116.220(c), 116.340(g) to Go to Small Claims COUrt .9 Plaintiff (list names) Metm %‘ mon-b Case Number: 5 C V A Z40 1 53 1 7 ® The Name: plaintiff (the Dcrri CL person, business, or public entity that R nymowj is suing) Phone: is: 95! - ‘f 90'§802 Street address: 7D b 8 5V CAMOI’C A lie # /08 MDHfC/elf Cl" 9 / 76 3 Street City State Zip Mailing address ('z'fdg'fferent): Street City State Zip Email address (ifavailable): Pa’ym onoL q (Q mgr, . Com If more than one plaintiff, list next plaintiff here: Name: Phone: Street address: Street City State Zip Mailing address ((fdiffel'ent): Street City State Zip Email address (ifavailable): D Check here ifmore than two plaintiff? and attachfbrm SC-IOOA. D Check here ifez'therplaintifflisted above ” is doing business under a fictitious name and attachfor'm SC—I 03. " D Check here zfany plaintiffis a “licensee 0r “deferred deposit originator (payday lender) under Financial Code sectians 23000 et seq. ® The defendant Name: weskrfi (the person, business, or public entity being suedJeifi-"J [Vefioné‘ PI’DPer‘H'e; DKA Wfimfljmpfl 4‘ hale: ena qt] 4). goz . (92 ao Street address: 8 i XL CV? ‘VQ Cf-"C‘Z TTVMQ C» QZb/L/ Street City State Zip Mailing address ({fdifferent): Street City State Zip Ifthe defendant is a corporation, limited liability company, or public entity, list the person ~ or a ent authorized for service of p rocess here: Nam: CY” "H" i? \31‘4 l‘+ Job title, ifknown: Mgm—bzm (w Address; 8 Ewcufim Cmcie irvme C’A qzu: IL/ Street City State Zip D Check here if'your case is against more than one defendant and attachfbrm SC-100A. D Check here z'fany defendant 1's 0n active military duty and write defendant ’S name here: The plaintiff claims the defendant $ )2 5‘00 owes (Explain below and on nextpage.) [ . (Note: A claimfor CO VID—19 rental debt cannot be made 0n thisform. Useform SC—SOO. Plaintiff’s Claim and ORDER to Go to Small Claims Court (COVlD-19 Rental Debt),) a. Why does the defendant owe the plaintiff money? 0V8 F pm D Rem + ReV-Novembe'1-20“ Plaintiff’s Claim and ORDER to Go to Small Claims Court $0100, P6962 °f6 ._>