SHORT TITLE: CASE NUMBER AND STATEMENT OF LOCATION CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION) This form is required pursuant to Local Rule 3 in all new civil case filings in the Los Angeles Superior Court. Item I. Check the types of hearing and fill in the estimated length of hearing expected for this case: JURY TRIAL? YES CLASS ACTION? YES LIMITED CASE? YES TIME ESTIMATED FOR TRIAL H.::::O.::::UR.::::S/D:!.:AY.!;!S Item II. Indicate the correct district and courthouse location 4 steps -If you checked "Limited Case", skip to Item III, Pg. 4): Step 1: After first completing the Civil Case Cover Sheet form, find the main Civil Case Cover Sheet heading for your case in the left margin below, and, to the right in Column A. the Civil Case Cover Sheet case type you selected. Step 2: Check Superior Court type of action in Column B below which best describes the nature of this case. Step 3: In Column C, circle the reason for the court location choice that applies to the type of action you have checked. For any exception to the court location, see Local Rule 3. Applicable Reasons for Choosing Courthouse Location see Column C below) 1. Class actions must be filed in the Stanley Mosk Courthouse, central district. 6. Location of property or permanently garaged vehicle. May be filed in central other county, or no bodily injury/property damage). 7. Location where petitioner resides. 3. Location where cause of action arose. 8. Location wherein defendant/respondent functions wholly. 4. Location where bodily injury, death or damage occurred. 9. Location where one or more of the parties reside. 5. Location where performance required or defendant resides. 1. Location of Labor Commissioner Office 11. Mandatory Filing Location Hub Case) Step 4: Fill in the information requested on page 4 in Item III; complete Item IV. Sign the declaration. A Civil Case Cover Sheet Category No. B Type of Action Check only one) C Applicable Reasons - See Step 3 Above Ot:: "5 «I- Auto 22) Uninsured Motorist 46) A71 Motor Vehicle - Personal Injury/Property DamageANrongful Death A711 Personal Injury/Property DamageANrongful Death - Uninsured Motorist 1.,,4. 1.,,4. >-t:: t:: Ie-S. CIl - <I) t:- O ::s - -c _ OJ - C CIl C... 3:... <I) -<I). OJ... CIl <I) E.c CIl 5 Asbestos 4) Product Liability 24) Medical Malpractice 45) Other Personal Injury Property Damage Wrongful Death 23) A67 Asbestos Property Damage A7221 Asbestos - PersonallnjurylWrongful Death A726 Product Liability not asbestos or toxic/environmental) A721 Medical Malpractice - Physicians & Surgeons A724 Other Professional Health Care Malpractice A725 Premises Liability e.g., slip and fall) A723 Intentional Bodily Injury/Property DamageANrongful Death e.g., assault, vandalism, etc.) A727 Intentional Infliction of Emotional Distress A722 Other Personal Injury/Property DamagelWrongful Death,4.,8. 1.,4. 1.,3. LACIV 19 Rev 3/15) LASC Approved 3-4 Local Rule 3 Page 1 of4
I SHORT TITLE: I CASE NUMBER A Civil Case Cover Sheet Category No. B Type of Action Check only one) C Applicable Reasons - See Step 3 Above Business Tort 7) >-1:: 1:: I- Civil Rights 8) Q...c: e- o.. Defamation 13)._- ::s ::s..=) I:: Fraud 16) ij I::... 3: f!?'q; ) Professional Negligence 25).. nl c E nl :zcl Other 35) A629 Other Commercial/Business Tort not fraud/breach of contract) A65 Civil Rights/Discrimination A61 Defamation slanderllibel) A613 Fraud no contract) A617 Legal Malpractice A65 Other Professional Malpractice not medical or legal) A625 Other Non-Personal Injury/Property Damage tort 1., 3.,3. C Wrongful Termination 36) E >- a. Other Employment 15) E w Breach of Contract! Warranty 6) not insurance) nl... Collections 9) C u Insurance Coverage 18) A637 Wrongful Termination A624 Other Employment Complaint Case A619 Labor Commissioner Appeals A64 Breach of Rental/Lease Contract not unlawful detainer or wrongful eviction) A68 ContractlWarranty Breach -Seller Plaintiff no fraud/negligence) A619 Negligent Breach of ContractlWarranty no fraud) A628 Other Breach of ContractlWarranty not fraud or negligence) A62 Collections Case-Seller Plaintiff A612 Other Promissory Note/Collections Case A634 Collections Case-Purchased Debt Charged Off Consumer Debt Purchased on or after January 1, 214) A615 Insurance Coverage not complex) 1.,5.,5. 1.,,5. 1.,, 5.,5.,6,11, 5, 11 5,6,11 1.,,5.,8. Other Contract 37) Eminent Domainllnverse Condemnation 14) Q.... Wrongful Eviction 33).. ij ::: Other Real Property 26)... Unlawful Detainer-Commercial I:: 31) Cl Unlawful Detainer-Residential 3 32) 'i nl Unlawful Detainer- "2 Post-Foreclosure 34) ::l Unlawful Detainer-Drugs 38) A69 Contractual Fraud A631 Tortious Interference A627 Other Contract Disputenot breachlinsurance/fraud/negligence) A73 Eminent Domain/Condemnation Number of parcels A623 Wrongful Eviction Case A618 Mortgage Foreclosure A632 Quiet Title A66 Other Real Property not eminent domain, landlord/tenant, foreclosure) A621 Unlawful Detainer-Commercial not drugs or wrongful eviction) A62 Unlawful Detainer-Residential not drugs or wrongful eviction) A62F Unlawful Detainer-Post-Foreclosure A622 Unlawful Detainer-Drugs,5.,5.,8.,6. LACIV 19 Rev 3/15) LASC Approved 3-4 Local Rule 3 Page 2 of4
I SHORT TITLE: A Civil Case Cover Sheet Category No. B Type of Action Check only one) I CASE NUMBER C Applicable Reasons - See Step 3 Above Asset Forfeiture 5) A618 Asset Forfeiture Case 3:.s: :: Ri 'u '6 ::l -, Petition re Arbitration 11) Writ of Mandate 2) A6115 Petition to Com pellconfirmnacate Arbitration A6151 Writ - Administrative Mandamus A6152 Writ - Mandamus on Limited Court Case Matter A6153 Writ - Other Limited Court Case Review,5.,8. CD Other Judicial Review 39) A615 Other Writ /Judicial Review,8. AntitrustlTrade Regulation 3) s:: C'CI Construction Defect 1) :::i >< Claims Involving Mass Tort c.. 4) E u Securities Litigation 28) Ri s:: Toxic Tort Environmental 3) 'iii 'S:... Insurance Coverage Claims a.. from Complex Case 41) A63 AntitrustlTrade Regulation A67 Construction Defect A66 Claims Involving Mass Tort A635 Securities Litigation Case A636 Toxic Tort/Environmental A614 Insurance Coverage/Subrogation complex case only),8. 1.,,5.,8. -s:: 1: E E OJ.)... 'C ::l -, -s:: w - Enforcement of Judgment 2) A616 Abstract of Judgment A617 Confession of Judgment non-domestic relations) A614 Administrative Agency Award not unpaid taxes) A6114 Petition/Certificate for Entry of Judgment on Unpaid Tax A6112 Other Enforcement of Judgment Case,9.,8.,8.,8.,9. A6141 Sister State Judgment,9.!/)!/) ::l 1: 'iii s:: c....!l:! E Ci) RICO 27) Other Complaints.) U Not Specified Above) 42)!/) :ill 'S: U Partnership Corporation Governance 21) A633 Racketeering RICO) Case A63 Declaratory Relief Only A64 Injunctive Relief Only not domestic/harassment) A611 Other Commercial Complaint Case non-tortlnon-complex) A6 Other Civil Complaint non-tortlnon-complex) A6113 Partnership and Corporate Governance Case,8.,8.!/)!/) ::l s:: s::..!l:! a; Other Petitions Not Ci) a.. Specified Above) 43).)!/) 'S: :ill U A6121 Civil Harassment A6123 Workplace Harassment A6124 Elder/Dependent Adult Abuse Case A619 Election Contest A611 Petition for Change of Name A617 Petition for Relief from Late Claim Law A61 Other Civil Petition,3.,9.,3.,9.,3.,9.,7.,3.,4.,8.,9. LACIV 19 Rev 3/15) LASC Approved 3-4 Local Rule 3 Page 3f4
SHORT TITLE: CASE NUMBER Item III. Statement of Location: Enter the address of the accident, party's residence or place of business, performance, or other circumstance indicated in Item II., Step 3 on Page 1, as the proper reason for filing in the court location you selected. REASON: Check the appropriate boxes for the numbers shown under Column C for the type of action that you have selected for this case. ADDRESS: 2 N. Spring Street 1. x x 3. : 4. x 5., 6. x 7. x 8. x 9. 1. 11. CITY: STATE: ZIP CODE: Los Angeles CA 912 Item IV. Declaration of Assignment I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that the above-entitled matter is properly filed for assignment to the Stanley Mosk courthouse in the District of the Superior Court of California, County of Los Angeles [Code Civ. Proc., 392 et seq., and Local Rule 3, subd.a). Dated: -=- -"'- PLEASE HAVE THE FOLLOWING ITEMS COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY COMMENCE YOUR NEW COURT CASE: 1. Original Complaint or Petition. If filing a Complaint, a completed Summons form for issuance by the Clerk. 3. Civil Case Cover Sheet, Judicial Council form CM-1. 4. Civil Case Cover Sheet Addendum and Statement of Location form, LACIV 19, LASC Approved 3-4 Rev. 3/15). 5. Payment in full of the filing fee, unless fees have been waived. 6. A signed order appointing the Guardian ad Litem, Judicial Council form CIV-1, if the plaintiff or petitioner is a minor under 18 years of age will be required by Court in order to issue a summons. 7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum must be served along with the summons and complaint, or other initiating pleading in the case. LAClV 19 Rev 3/15) LASC Approved 3-4 Local Rule 3 Page 4 of4
." FIRM: MICHEL 8: ASSOCIATES, P.c.. 18 E. OCEAN BLVD. SUITE 2 LONG' BEtwH CA 982 PH: 562/216-4444 ATTEYF E# 1169797 RETURN TODAY Long Beach Torrance Fax 31-316-1256 I 562-595-6294?) sfb4;},;ll "... Ctr"fNUM8ER: ;:d;;rf9f:jss:. FEES PAID/ DATE '$ 4"'")...,----' FEES ATTACHED., JV..,I I ), I I NSTR UCTIO NS: ' 2-? lj? SERVE BY \ b l Z? t-----""o.!-!,ff-,-",ic-;;.e =US::.=-E,---_ COURT DfPT. CLERK IMPORTANT./ FILE SERVE DELIVER COpy OTHER 9\C'cil)U -h\-u at S\z;\V1 \ C\f N ts - \-f 'id\a Ylo1\J6 CAY\"I \7YD'p\ewt J f1et\)e ml\ Lc\1)f'tt CiI+ ) Z\p YL)LJ, -tv'c1 Vt "'I )L, PROCESS. DELiVERY RETURN ADVFEE ADVCHG: TIME. POSTAGE COPIES D RESIDENCE D BUSINESS DATE -tf-->lt--"" DATE 2'" SUBMIT RUNNERl NO CONFORM CorporateMailingAddress:P.O.Borl198"5 LongBeach.CA 989-1985,)FtIGINAL r., I
LASC - F I LI NG::; 111 N. HILL STREET LOS AI-l!3ELES Ci 912 DATE PAID: 1/23/15 11 :22 At,; RECEIPT :\I: CCH524:3866 CIT/CASE: LEA/DEF#: 8S158682 PAVfENT RECEIVE[): CHECK: CASH: CHANGE: CARD $435,1 31 $435, $. $, $,