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Plaintiff's Claim and ORDER
to Go to Small Claims Court
Notice to the person being sued:
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.
You are the defendant if your name is listed in & on page 2 of this form.
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 lo demanda es el Demandante, la que figura en
@ 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 podrfa ordenar que le quiten de su sueldo, dinero u
otros bienes para pagar este reclamo.
Lleve testigos, recibos y cualquier otra prueba que necesite para probar su
caso.
Clerk stamps date here when form is filed.
FILED
‘San Francisco County Superior Court
MAR 16 2021
K OF THE COURT
Deputy Cari”
GLE
ey
ee!
Fill in court name and street address:
Superior Court of California, County of
San Francisco
Small Claims Division
400 McAllister Street
San Francisco, CA 94102
Court fills in case number when form is filed.
CORF21-98604190
Case Name:
CCSF, MTA vs. Dong Qize
Lea este formulario y todas las paginas adjuntas para entender la demanda en su contra y para proteger sus derechos.
elco(Ts CoM CToM Com ezel ai
The people in (1) and @) must go to court: (Clerk fills out section below.)
> Date Time Department Name and address of court, if different from above
“sUN 22 2021_pZopu 306 St FLOR
2. /
3.
Date: 3 f 40 / 2/ — Cletk,by Ce -r , 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-100-INFO, Information for the Plaintiff, to know your rights. Get
SC-100-INFO at any courthouse or county law library, or go to www.courts.ca. gov/smallclaims/forms.
Fill out pages 2 and 3 of this form. Then make copies of all pages of this form. (Make one 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 court-stamped
copy of all five 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 Caitfomia, www.courts.ca.gov
Revised January 1, 2017, Mandatory Form
Code of Civil Procedure, 8§ 116.110 et seq.,
116.20(6), 116.340(g)
Plaintiff's Claim and ORDER
to Go to Small Claims Court
(Small Claims)
‘SC-100, Page 1 of 5
?Plaintiff (list:names):
. CCSF, MTA vs. Dong Qize
: @ The plaintiff (the person, business, or public entity that is suing) is:
Name: City and County of San Francisco, MTA. ___ = Phone::i415-554-3909--:
Street address: 1390 Market Street, 7th Floor. le .San-Francisco..:.._.-CA:~;.94102....
. Street City State ° Zip
Mailing address (if different):
Street +. City State Zip.
~-lf more-than one plaintiff, list next ‘plaintiff here: bon
Name: = : Phone:
‘Street address: :
, Street, . City State Zip
Mailing address (if different): : ceneSthy cater fet re
Street : City State, . Zip -
OO Check here if more than two plaintiffs and attach form SC-100A.
Check tere if either plaintiff listed above i. is doing business under a fictitious name. If so, attach form SC- 103.
“2 Check here ifany ‘plain iff isa “licensee” or “deferred deposit originator” (payday lender) under Financial
Code sections 23000 et seq.
: @) The defendant(the person, business, or public entity being sued) is:
Name: Dong Qize os : Phone: _
Street address: 3700 Parkview Lane, ‘Apt 2B. vote oe ewine 3 ater CA» -'92612
Street . Gity State’ Zip
Mailing address (if different):.1140 Synergy. __ Irvine CA 92614
Street
If the defendant is a corporation, ‘co
or agent authorized for service of process here:
Name: - Job titlé, if known: “ L Li
Address: a. . -
Street City State Zip
ity State Zip .
mpany, or public entity, list the person.
0 Check here if your case is against more.than one defendant, and attach form SC-100A.
1 Check here if any defendant is on active military duty, and ‘write his or her name here:
® The plaintiff claims the defendant owes $ 1,338.99 z=.. (Explain below):
a. Why does the defendant owe the plaintiff money?
Defendant hit and run collided with City bus.
~ When did this happen? (Date): 01/07/2020
b. Ifno specifi ic date, give the time period: Date state .
Through:
¢. How did.you calculate the money owed to. you? (Do not include court costs or, fees. for service.)
“Repair estimate from MTA Woods Body Shop. _
O Check.here re ify ‘you need more. space..Attach one sheet. of paper.or. form MC-031 and) write., “SC-I ‘-100, ‘Item 3”.at
the top.
‘eves iowa 1207 Plaintiff's Claim,aPlaintiff (list names): . , Case Number:
CCSF, MTA vs. Dong Qize
@ You must ask the defendant (in person, in writing, or by phone) to pay you before you
sue. If your claim is for possession of property, you must ask the defendant to give you
the property. Have you done this?
Eid Yes [No If no, explain why not: °
® Why are you filing your claim at this courthouse?
This courthouse covers the area (check the one that applies):
a. EJ (1) Where the defendant lives or does business. (4) Where a contract (written or spoken) was made,
(2) Where the plaintiff’s 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. [) 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. (] Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about a
retail installment contract (like a credit card). (Civ Code, § 1812.10.)
d. [1 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 finance sale. (Civ Code, § 2984.4.)
e. [] Other (specify):
©) List the zip code of the place checked in ©) above (if you know): 92614
@® Is your claim about an attorney-client fee dispute? [] Yes [J No
If yes, and if you have had arbitration, fill out form SC-101, attach it to this form, and check here: (]
Are you suing a public entity? [] Yes [] No
If yes, you must file a written claim with the entity first. [] 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.
Have you filed more than 12 other small claims within the last 12 months in California?
J Yes [] No Ifyes, the filing fee for this case will be higher.
Is your claim for more than $2,500? [] Yes {J No
If yes, 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.
| understand that by filing a claim in small claims court, | have no right to appeal this
claim.
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.
Date: 2/16/2021 Virginia Ho >
Plaintiff types or prints name here Plaintiff sign here *
Date: >
: Second plaintiff types or prints name here Second(plathtiff signs here
Requests for Accommodations
Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter
services are available if you ask at least five days before the trial. Contact the clerk’s office for form
MC-410, Request for Accommodations by Persons With Disabilities and Response. (Civ. Code, § 54.8.)
Fesiced Janwary 1, 2017 Plaintiff's Claim and ORDER to Go to Small Claims Court SC-100, Page 3 of 5
(Small Claims) >ion for the defendant (the person being sued)...’
“Small.claims. court" -is-a special court. where claims ‘for
$10,000. ided
Corporations, Sartrerstipe, 6 pl
are limited to claims of $5,000. (See below for exceptions.*) The
process is quick and cheap. The rules are simple and informal:
You are the defendant—the person being. sued. The person who is
suing You is the plaintiff. ~~
Do T needa lawyer? You may talkto a lawyer befé
the case. But you may not have a lawyer represent you in cotirt’* ~
- (unless this is an appeal from a small claims case).
How’do'l get ready for court? You don’t have to'filé any
papers'before your ttial,unless* you-think'this is thé wrong court
for-your case. But bring to your-trial any witnesses, receipts, and
evidence that supports your. ca: And read “Be Prepared for Your
‘al F
‘fill out forrn’ MC-410, Request for
Accommodations. Give the form to your court clerk or the ADA/
Access:Coordinator.
What if | don’t speak English well? ‘Ask-the court‘clérk
as.soon as possible. if your court hi ‘ourt-provided.| terpreter
available and how to request.one. A ¢ court-pro| ided interpreter may.
not be available. Alternatively, you may bri
witness or an attorney to interpret for you or ask the court for a list
of interpreters | for hire.
Where can | get the court forms I need? Go to any, .
courthouse or-your-county law library;or print forms at ww.
courts.ca.gov/smaliclaims/forms. :
What happens at the trial? } The | judge will listen. to both .
sides. The judge may make a decision at your trial or mail the
decision to you later.
What if.I lose the, case? If you 'lose, you may’appeal. You'll
have to-pay a fee::(Plaintiffs carinot appeal their own‘claims.)
elf you, were.at: the-trial, file.form,SC-140, Notice. of Appeal. You...
must file within’ 30 days after the clerk hands or mails you the
judge's decision (judgment) on form SC-200 or form SCH 30;"
Notice of Entry of Judgment.
« Ifyou were not at the trial, fill out and file form SC- 135: Notice of
‘Motion to Vacate Judgment ‘and Declaration, ‘to ask the judge to
cancel the judgment (decision). If the judge does not give you a
new trial? ydushave 40: days'to appeal the’decision: File form +
SC-140.
Yes. If you are beirig sue you can?
+ Settle your case before the trial. if you and the
plaintiff agree on How'to settle’the.case, the plaintiff must file
form CIV-110, Request for Dismissal, with the clerk. Ask the
‘Small Claims Advisor for help.
rafter, for
in adult Who is not a.
. « Prove-this.is-the-wrong-court.Send.a-letter-to-the-court
Go to the'trial'and try to win your. cases Bring:
. .Witnesses,, receipts, and any evidence you need to.prove.your
case. To have the court order a witness to go to the trial, fill out
*
against! :theiplaintiff; and the claim is appropriate for small-claims
courtsas.described on this form;. ryoumay: file: Defendant's Claim
(form SC-120) he, claim action. If your claim is
for more thant in'small claims court, you’ may still file it in
small claims court if you give up the amount over the small
- claims valuie:amount,’or-yourmay file a:claim:for- -the full value of
* the claim.in the appropriate court. If your-claim is for more than
same contract,
of the plaintiffs
‘court and file a
‘Court to resolve
of the amounts
allowed in’small claims court and relate
transaction, matter, or event that is the sul
y
motion ito transfer'the:plaintiff's:'s:claim:tos
, both.matters.together. You.can,
h
money,.-Or; if-you can’t pay-the money now, go to your trial
and say you.want to.make. payments.
Let-the-case-defa If you‘don't settle.arid do. not go.to
the trial (default), the ‘judge may give the plaintiff what he or she
-is:asking;for-plus: courtcosts: Ifthis:happens; the:plaintiff cans
legally take. your money, wages,.and. property to pay the:
judgment.
Whatif 1 heed
You éaii‘ ‘charige’ ‘the trial date if!
-«-You:cannot go.to.court onthe scheduled date, (youwill :have to
+ You'did not g g
15:days before'the:trial(or 20:days if you live outside’ the:
county),..oF. . . . .
« You need more ti
** allowed, ‘and you will n
Ask the Small Claims‘Cler
Postponing atrial. Or‘fill:
mail it to the court and to all other people listed on yor
Papers before the deadline. Enclose a ch
unless a fee waiver wa: y Granted. °
SC-100,:Page 4 of 5
RDER Claims)~.
Informacion para el demandado (la persona demandada)
La “Corte de reclamos menores” es una corte especial donde se
deciden casos por $10,000 o menos. Los individuos, o sea las
“personas fisicas” y los propietarios por cuenta propia, pueden
reclamar hasta $10,000. Las corporaciones, asociaciones, entidades
publicas y otras empresas solo pueden reclamar hasta $5,000. (Vea
abajo para las excepciones.*) El proceso es rapido y barato. Las
reglas son sencillas e informales. Usted es el Demandado—la
persona que se esté demandando. La persona que lo esta
demandando es el Demandante.
eNecesito un abogado? Puede hablar con un abogado antes o
después del caso. Pero no puede tener a un abogado que lo
Tepresente ante la corte (a menos que se trate de una apelacién de un
caso de reclamos menores).
~Cémo me preparo para ir a la corte? No tiene que presentar
ningunos papeles antes del juicio, a menos que piense que ésta es la
corte equivocada para su caso. Pero lleve al juicio cualquier testigos,
recibos y pruebas que apoyan su caso. Y lea “Esté preparado para su
juicio” en www.courts.ca.gov/reclamosmenores/preparese.
Qué hago si necesito una adaptacion? Si tiene una discapacidad
0 tiene impedimentos de audicién, llene el formulario MC-410,
Request for Accomodations. Entregue el formulario al secretario de la
corte o al Coordinador de Acceso/ADA de su corte.
éQué pasa si no hablo bien inglés? Pregitintele al secretario de la
corte lo mas pronto posible si en el juzgado habra un intérprete
disponible y cémo solicitarlo. No siempre estan disponibles los
intérpretes de la corte. Otra opcidn es llevar a un adulto que pueda
interpretar para usted siempre que esa persona no sea un testigo ni
un abogado. O puede pedir a la corte una lista de intérpretes
particulares disponibles para contratar.
eDGnde puedo obtener los formularios de la corte que necesito?
Vaya a cualquier edificio de la corte, la biblioteca legal de su condado,
0 imprima los formularios en www.courts.ca.gov/ smaliclaims/forms
(pagina esta en inglés).
~Qué pasa en el juicio? El juez escuchara a ambas partes. El juez
puede tomar su decisién durante la audiencia o enviarsela por correo
después.
zQué pasa si pierdo el caso? Si pierde, puede apelar. Tendra que
pagar una cuota. (El Demandante no puede apelar su propio reclamo.)
« Si estuvo presente en el juicio, Ilene el formulario SC-140, Aviso de
apelaci6n (Notice of Appeal). Tiene que presentarlo dentro de 30
dias después de que el secretario le entregue o envie la decisién
(fallo) del juez en el formulario SC-200 o SC-130, Aviso de
publicacién del fallo (Notice of Entry of Judgment).
Si no estuvo en el juicio, lene y presente el formulario SC-135,
Aviso de peticién para anular el fallo y Declaracién para pedirle al
juez que anule el fallo (decisién). Si la corte no le otorga un nuevo
Juicio, tiene 10 dias para apelar la decisién. Presente el formulario
SC-140.
Para obtener mas informacion sobre las apelaciones, vea www.
courts.ca.gov/reclamosmenores/apelaciones.
éTengo otras opciones? Si. Si lo estan demandando, puede:
« Resolver su caso antes del juicio. Si usted y el Demandante se
ponen de acuerdo en cémo resolver el caso, el Demandante tiene
que presentar el formulario CIV-110, Solicitud de desestimacién
(Request for Dismissal) ante el secretario de la corte. Pidale al
Asesor de Reclamos Menores que lo ayude.
« Probar que es ld corte equivocada. Envie una carta a la corte
antes del juicio explicando por qué cree que es la corte
equivocada. Pidale a la corte que despida el reclamo.Tiene que
entregar (dar) una copia de su, carta (por correo 9 en persona) a
todas las partes. (Su carta a la corte tiene que decir que hizo la
entrega.) A
« Iraljuicio y tratar de ganar el caso. Lleve testigos, recibos y
cualquier prueba que necesite para probar su caso. Si desea que
la corte emita una orden de comparecencia para que los testigos
vayan al juicio, llene el formulario SC-107, Citatorio de reclamos
menores (Small Claims Subpoena) y entrégueselo legalmente al
testigo. .
« Demandar a la persona que lo demand6. Si tiene un reclamo
contra el Demandante, y el reclamo se puede presentar en la
corte de reclamos menores, tal como se describe en este
formulario, puede presentar el formulario SC-120, Reclamo del
demandado (Defendant's Claim) y presentarlo en este mismo
caso. Si su reclamo excede el limite permitido en la corte de
reclamos menores, puede igualmente presentarlo en la corte de
reclamos menores si esta dispuesto a limitar su reclamo al
maximo permitido, o puede presentar un reclamo por el monto
total en la corte apropiada. Si su reclamo excede el limite
permitido en la corte de reclamos menores y esta relacionado con
el mismo contrato, transaccidn, asunto o acontecimiento que el
reclamo del Demandante, puede presentar su reclamo en la corte
apropiada y presentar una mocién para transferir el reclamo del
Demandante a dicha corte, para poder resolver los dos reclamos
juntos. Puede ver una descripcidn de los montos permitidos en el
parrafo anterior titulado “Corte de reclamos menores”.
« Aeptar el reclamo del Demandante y pagar el dinero. O, sino
puede pagar en ese momento, vaya al juicio y diga que quiere
hacer los pagos.
No ir al juicio y aceptar el fallo por falta de comparecencia. Si
no llega a un acuerdo con el Demandante y no va al juicio (fallo
por falta de comparecencia), el juez le puede otorgar al
Demandante lo que esta reclamando mas los costos de la corte.
En ese caso, el Demandante legalmente puede tomar su dinero,
su sueldo 0 sus bienes para cobrar el fallo.
éQué hago si necesito mas tiempo? Puede cambiar la fecha del
juicio si:
* No puede ir a la corte en la fecha programada (tendra que pagar
una cuota para aplazar el juicio), 0
* No le entregaron los documentos legalmente (no recibié la orden
para ir a la corte) por lo menos 15 dias antes del juicio (6 20 dias
si vive fuera del condado), o .
+ Necesita mas tiempo para conseguir intérprete. (Se permite un
solo aplazamiento sin tener que pagar cuota para aplazar el
juicio).
Preguntele al secretario de reclamos menores sobre las reglas y las
cuotas para aplazar un juicio. O Ilene el formulario SC-150 (0 escriba
una carta) y envielo antes del plazo a la corte y a todas las otras
personas que figuran en sus papeles de la corte. Adjunte un cheque
para pagar los costos de la corte, a menos que le hayan dado una
exencion.
zNecesita ayuda? El Asesor de Reclamos Menores de su
condado le puede ayudar sin cargo.
_
O visite www.courts.ca.gov/reclamosmenores/asesores.
* Excepciones: Existen diferentes limites en un reclamo contra un garante. (Vea el Cédigo de Procedimiento Civil, seccién 116.220 (c).)
Revised January 1, 2017
Reclamo del Demandante y ORDEN
SC-100, Page 5 of 5
Para Ir a la Corte de Reclamos Menores
(Reclamos Menores)