Fillable APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL (Superior Court of California)

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APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL (Superior Court of California)

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Proceedings to be covered (for example, bail hearing, preliminary hearing, trial, sentencing hearing, family, probate, juvenile):
Applicant requests accommodation under rule 1.100 of the California Rules of Court, as follows:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Date or dates needed (specify):
Medical condition necessitating accommodation (specify):
5.
3.
6.
Type of proceeding:
(SIGNATURE)
2.
Criminal
(TYPE OR PRINT NAME)
1. Civil Other:
4.
Type or types of accommodation requested (specify):
Special requests or anticipated problems (specify):
Cal. Rules of Court, rule 1.100
www.courts.ca.gov
For the following duration:
MC-410
RESPONSE
Page 1 of 1
For the following reason (attach additional pages, if
necessary): [See Cal. Rules of Court, rule 1.100(g), for
the review procedure]
(SIGNATURE)
REQUEST FOR ACCOMMODATIONS BY PERSONS
WITH DISABILITIES AND RESPONSE
APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL
The accommodation request is GRANTED and
the court will provide the
The accommodation is DENIED in whole or in part
because it
Form Approved for Optional Use
Judicial Council of California
MC-410 [Rev. July 1, 2017]
requested accommodation, in whole
requested accommodation, in part (specify below):
Date response delivered in person or sent to applicant:
SIGNATURE FOLLOWS THE LAST PAGE OF THE RESPONSE.
APPLICANT (name):
APPLICANT is Witness
Juror Attorney Party Other
Person submitting request (name):
(Specify)
TELEPHONE NO.:
APPLICANT'S ADDRESS:
NAME OF COURT
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
Judge:
CASE NUMBER:
REQUEST FOR ACCOMMODATIONS BY PERSONS
WITH DISABILITIES AND RESPONSE
Case Title:
(TYPE OR PRINT NAME)
For the above matter or appearance
(dates):
From to
Indefinite period
fails to satisfy the requirements of rule 1.100.
creates an undue burden on the court.
fundamentally alters the nature of the service,
program, or activity.
The court will provide the alternative
accommodation as follows:
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APPLICANT'S INFORMATION TO BE KEPT CONFIDENTIAL (Superior Court of California)

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Completed 29 July 2020

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