Declaration In Support Of Plaintiffs Claim {SC 1}

DECLARATION IN SUPPORT OF PLAINTIFF S CLAIM Kings County Local Form Kings County Superior Court Local Rule 403(E) SC 1 (Rev6/1/16 ) [CCP 247116.540(f)] Optional Form 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF KINGS 1. I am the Plaintiff in this small claims matter and am currently incarcerated in a county jail, a Department of Corrections facility, or a Youth Authority facility. 2. I request damages ( exclusive of fees and costs) be awarded in my fa vor and against Defendant(s), as follows: Name of Defendant: Amount of Damages: 3. I also r equest an award of costs (filing fees and service costs) against the Defendant(s) in the amount of $. 4. The alleged breach of duty or contract occurred on . 5. The facts supporting my claim for damages are as follows: (additional pag es attached? Y or N [circle one]. Label . ) , Plaintiff, vs. , Defendant (s) . No. DECLARATION IN SUPPORT OF PLAINTIFF S CLAIM [CC P 247116.540(f) ] American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION IN SUPPORT OF PLAINTIFF S CLAIM Kings County Local Form Kings County Superior Court Local Rule 403(E) SC 1 (Rev. 6/1/16) [CCP 247116 .540(f)] Optional Form Page 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 6. I [ have ] or [ have not ] (circle one) , attached document s in support of my claim. Identify name and relevance of any document attached to Declaration. Name of Document: Relevance to Claim : (Exh. 6(A)) (Exh. 6(B)) (Exh. 6(C)) (Exh. 6(D)) (Exh. 6(F)) (additional page s attached? Y or N [circle one] . Label Exhibits as Exhibit 6(G) through 6(Z) as appropriate . ) 7. Prior to filing this Declaration, I [did] or [did not] (circle one) make a demand for payment to the Defendant(s). If I did not make a demand for payment to one or more of the Defendants , the reason I did not do so is: 8. Prior to filing this Declaration, I [did] or [did not] (circle one) exhaust all availa ble administrative remedies against the Defendant(s). ( Mark one ) Code of Regulations, title 15, Section 3084.1, et. seq., was re ceived on: (date) [ ] I have because: American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION IN SUPPORT OF PLAINTIFF S CLAIM Kings County Local Form Kings County Superior Court Local Rule 403(E) SC 1 (Rev. 6/1/16) [CCP 247116 .540(f)] Optional Form Page 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 9. Prior to filing this Declaration, I [did] or [did not] (circle one) file a claim with ( Mark one ) [ ] My claim was denied on (date) [ ] I did not file a claim with the VCGCB because: 10. judge to hear this matter. I understand that a temporary judge is a quali fied member of the State Bar and that I have a right to have the matter heard before a judge, commissioner, or referee of the court. 1 11. I declare under penalty of perjury under the laws of the State of California that the foregoing, and all matters sta ted in the attached pages hereto are true and correct to the best of my personal knowledge. As to those matters stated on information and belief, I believe the same to be true and correct. This Declaration in was executed b y me on , 20 at (identify address where executed). Print Name of Declarant Signature of Declarant NOTICE : This Declaration must be filed with t he court at least 5 court days prior to the hearing scheduled in your small claims case. Unless good cause has been shown to exist, a copy of this Declaration and all attachments must be served upon the Defendant ( s ) prior to the hearing. American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION IN SUPPORT OF PLAINTIFF S CLAIM Kings County Local Form Kings County Superior Court Local Rule 403(E) SC 1 (Rev. 6/1/16) [CCP 247116 .540(f)] Optional Form Page 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PROOF OF SERVIC E BY MAIL * * * STATE OF CALIFORNIA ) ) ss. No. COUNTY OF KINGS ) I hereby declare under penalty of perjury that I am over the age of eighteen (18) years and not a party to this action. I further declare under penalty of perjury tha t on , 20 , and in accordance with the procedures for the mailing of documents employed by ( prison name ), I served the attached DECLARATION IN SUPPO AIM via first class mail by depositing a true copy the reof, enclosed in a sealed envelope with postage fully paid, either in the designated box and/or with the appropriate designated prison official. The envelope was address, as follows: Executed on , 20 , at Hanford, California. (Name) American LegalNet, Inc. www.FormsWorkFlow.com