Form Adopted for Mandatory Use
Judicial Council of California
CM-011 [Rev. September 1, 2018]
CONFIDENTIAL COVER SHEET
FALSE CLAIMS ACTION
Gov. Code, § 12652(c)
Cal. Rules of Court, rules 2.570-2.573
www.courts.ca.gov
Page 1 of 1
CM-011
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR:
PLAINTIFF OTHER
(SPECIFY):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
[UNDER SEALl]
[UNDER SEALl]Plaintiff
Defendant
CONFIDENTIAL COVER SHEET–FALSE CLAIMS ACTION
FOR COURT USE ONLY
CASE NUMBER:
CONFIDENTIAL
Date:
INSTRUCTIONS: This civil action is brought under the False Claims Act,
Government Code section 12650 et seq. The documents filed in this case
are under seal and are confidential pursuant to Government Code section
12652(c).
UNLESS:
(1) Motion to extend time is
pending; or
(2) Extended by court order
This Confidential Cover Sheet must be affixed to the caption page of the
complaint and to any other paper filed in this case until the seal is lifted.
You should check with the court to determine whether papers filed in
False Claims Act cases must be filed at a particular location.
The document to which this cover sheet is affixed is:
a.
b.
c.
d.
e.
f.
g.
h.
This Confidential Cover Sheet and the attached document must each be separately file-stamped by the clerk of the court.
Complaint for damages for violation of the False Claims Act
Seal to expire on (date):
Civil Case Cover Sheet (form 982.2(b)(1))
Motion for an extension of time to intervene
Affidavit or other document in support of the motion for an extension of time
Order extending time to intervene
(specify date order expires):
Other order
(describe):
Notice from the Attorney General of additional prosecuting authority that may have access to the file
Other
(describe):
1.
2.
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