3. TO THE CLERK: Consent to the above dismissal is hereby given.**
REQUEST FOR DISMISSAL
Form Adopted for Mandatory Use
Judicial Council of California
CIV-110 [Rev. Jan. 1, 2013]
Code of Civil Procedure, § 581 et seq.; Gov. Code,
§ 68637(c); Cal. Rules of Court, rule 3.1390
www.courts.ca.gov
Page 1 of 2
TO THE CLERK: Please dismiss this action as follows:
(1)
(2)(1)
(3)
(4)
(5)
(6)
(TYPE OR PRINT NAME OF
(SIGNATURE)
Attorney or party without attorney for:
Plaintiff/Petitioner Defendant/Respondent
Cross Complainant
(SIGNATURE)
** If a cross-complaint – or Response (Family Law) seeking affirmative
relief – is on file, the attorney for cross-complainant (respondent) must sign
this consent if required by Code of Civil Procedure section 581 (i) or (j).
*If dismissal requested is of specified parties only of specified causes of action only,
or of specified cross-complaints only, so state and identify the parties, causes of
action, or cross-complaints to be dismissed.
(To be completed by clerk)
4.
5
6.
7.
Clerk, by , Deputy
2.
The court waive court fees and costs for a party in this case. (This information may be obtained from the
clerk. If court fees and costs were waived, the declaration on the back of this form must be completed).
a.
(Complete in all cases except family law cases.)
With prejudice Without prejudice
Complaint
Petition
Cross-complaint filed by
(name): on (date):
Cross-complaint filed by
(name): on (date):
Entire action of all parties and all causes of action
Other
(specify):*
did did not
Date:
ATTORNEY
PARTY WITHOUT ATTORNEY)
Dismissal entered as requested on
(date):
Dismissal entered on
(date): as to only (name):
Dismissal not entered as requested for the following reasons
(specify):
Attorney or party without attorney notified on
(date):
Attorney or party without attorney not notified. Filing party failed to provide
a copy to be conformed
means to return conformed copy
Date:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
Plaintiff/Petitioner:
Defendant/Respondent:
FOR COURT USE ONLY
CASE NUMBER:
REQUEST FOR DISMISSAL
CIV-110
ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
STATE BAR NO:
TELEPHONE NO.: FAX NO. :
E-MAIL ADDRESS:
ATTORNEY FOR (Name):
This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action in a class
action. (Cal. Rules of Court, rules 3.760 and 3.770.)
A conformed copy will not be returned by the clerk unless a method of return is provided with the document.
a.
b.
1.
b.
(2)
(TYPE OR PRINT NAME OF
Date:
ATTORNEY
PARTY WITHOUT ATTORNEY)
Attorney or party without attorney for:
Plaintiff/Petitioner Defendant/Respondent
Cross Complainant
Declaration Concerning Waived Court Fees
1.
3.
The person named in item 1 is (check one below):
a.
b.
c.
REQUEST FOR DISMISSAL
CIV-110 [Rev. January 1, 2013]
Page 2 of 2
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
(TYPE OR PRINT NAME OF
(SIGNATURE)
COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS
If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or more in
value by way of settlement, compromise, arbitration award, mediation settlement, or other means, the
court has a statutory lien on that recovery. The court may refuse to dismiss the case until
the lien is
satisfied. (Gov. Code, § 68637.)
The court waived court fees and costs in this action for (name):
not recovering anything of value by this action.
recovering less than $10,000 in value by this action.
recovering $10,000 or more in value by this action. (If item 2c is checked, item 3 must be completed.)
All court fees and court costs that were waived in this action have been paid to the court (check one):
Yes
No
Date:
ATTORNEY PARTY MAKING DECLARATION)
CASE NUMBER:
Plaintiff/Petitioner:
Defendant/Respondent:
CIV-110
2.
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