PI/PD - Complaint SAMPLE - California

1 SAMPLE Use the samples to help you complete the packet of blank forms. PI/PD - Complaint CM-010 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):FOR COURT USE ONLYTELEPHONE NO.:FAX NO.:ATTORNEY FOR (Name):SUPERIOR COURT OF California , COUNTY OFSTREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME:CASE NAME:CIVIL CASE COVER SHEETCASE NUMBER:Complex Case DesignationUnlimitedLimitedCounterJoinde r(Amount(AmountFiled with first appearance by defendantdemandeddemanded isJUDGE:(Cal. Rules of Court, rule )exceeds $25,000) $25,000 or less)DEPT.:Items 1-6 below must be completed (see instructions on page 2).

2 1. Check one box below for the case type that best describes this case:Auto TortContractProvisionally Complex Civil LitigationAuto (22)Breach of contract/warranty (06)(Cal. Rules of Court, rules )Uninsured motorist (46)Rule collections (09)Antitrust/Trade regulation (03)Other PI/PD /WD (Personal Injury/PropertyInsurance coverage (18) construction defect (10)Damage/Wrongful Death) TortOther contract (37)Mass tort (40)Asbestos (04)Real PropertySecurities litigation (28)Product liability (24)Eminent domain/InverseEnvironmental/Toxic tort (30)Medical malpractice (45)condemnation (14)Insurance coverage claims arising from theOther PI/PD /WD (23)Wrongful eviction (33)above listed provisionally complex caseNon- PI/PD /WD (Other) TortOther real property (26)types (41)

3 Business tort /unfair business practice (07)Unlawful DetainerEnforcement of JudgmentCivil rights (08)Commercial (31)Enforcement of judgment (20)Defamation (13)Residential (32)Miscellaneous Civil ComplaintFraud (16)Drugs (38)RICO (27)Intellectual property (19)Judicial ReviewOther Complaint (not specified above) (42)Professional negligence (25)Asset forfeiture (05)Miscellaneous Civil PetitionOther non- PI/PD /WD tort (35)Petition re: arbitration award (11)Partnership and corporate governance (21)Other petition (not specified above) (43)EmploymentWrit of mandate (02)Wrongful termination (36)Other judicial review (39)Other employment (15)2.

4 This caseisis notcomplex under rule of the California Rules of Court. If the case is complex, mark thefactors requiring exceptional judicial number of separately represented number of motion practice raising difficult or with related actions pending in one or more courtsissues that will be time-consuming to resolvein other counties, states, or countries, or in a federal amount of documentary postjudgment judicial supervision3. Remedies sought (check all that apply) ; declaratory or injunctive Number of causes of action (specify):5. This caseisis nota class action If there are any known related cases, file and serve a notice of related case.

5 (You may use form CM-015.)Date:(TYPE OR PRINT NAME)(SIGNATURE OF PARTY OR ATTORNEY FOR PARTY)NOTICE Plaintiff must file this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases filedunder the Probate Code, Family Code, or Welfare and Institutions Code). (Cal. Rules of Court, rule ) Failure to file may resultin sanctions. File this cover sheet in addition to any cover sheet required by local court rule. If this case is complex under rule et seq. of the California Rules of Court, you must serve a copy of this cover sheet on allother parties to the action or proceeding.

6 Unless this is a collections case under rule or a complex case, this cover sheet will be used for statistical purposes 1 of 2 Form Adopted for Mandatory UseCIVIL CASE COVER SHEETCal. Rules of Court, rules , , , ;Judicial Council of CaliforniaCal. Standards of Judicial Administration, std. [Rev. July 1, 2007] collections (09) YOUR NAMEYOUR STREET ADDRESSYOUR CITY, STATE, ZIP CODEYOUR PHONE#IN PRO PERSANTA CLARACHECK WITH STAFF CIVILYOUR LAST NAME NAME OF THE PERSON YOU ARE SUINGLEAVE BLANKLEAVE BLANKLEAVE BLANK # OF CAUSES OF ACTION ATTACHED TODAY'S DATEPRINT YOUR NAMESIGN YOUR NAMESHC SAMPLE CHECK THE CORRECT BOX(ES) INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEETTo Plaintiffs and Others Filing First complete and file, along with your first paper, the Civil Case Cover Sheet statistics about the types and numbers of cases filed.

7 You must complete items 1 through 6 on the sheet. In item 1, you must check one box for the case type that best describes the case. If the case fits both a general and a more specific type of case listed in item 1, check the more specific one. If the case has multiple causes of action, check the box that best indicates the primary To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A coversheet must be filed only with your initial paper. Failure to file a cover sheet with the first paper filed in a civil case may subject a party, its counsel, or both to sanctions under rules and of the California Rules of Parties in Complex complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the case is complex.

8 If a plaintiff believes the case is complex under rule of the California Rules of Court, this must be indicated by completing the appropriate boxes in items 1 and 2. If a plaintiff designates a case as complex, the cover sheet must be served with the Complaint on all parties to the action. A defendant may file and serve no later than the time of its first appearance a joinder in the plaintiff's designation, a counter-designation that the case is not complex, or, if the plaintiff has made no designation, a designation that CASE TYPES AND EXAMPLESAuto TortContractProvisionally Complex Civil Litigation ( (22)-Personal Injury/PropertyBreach of Contract/Warranty (06)Rules of Court Rules )Damage/Wrongful DeathBreach of Rental/LeaseUninsured Motorist (46) (if theContract (not unlawful detainerAntitrust/Trade Regulation (03)case involves an uninsuredor wrongful eviction) construction Defect (10))

9 Motorist claim subject toContract/Warranty Breach-SellerClaims Involving Mass tort (40)arbitration, check this itemPlaintiff (not fraud or negligence)Securities Litigation (28)instead of Auto)Negligent Breach of Contract/Environmental/Toxic tort (30)Other PI/PD /WD (Personal Injury/WarrantyInsurance Coverage ClaimsProperty Damage/Wrongful Death)Other Breach of Contract/Warranty(arising from provisionally complex TortCollections ( , money owed, opencase type listed above) Asbestos (04)book accounts) (09)Asbestos Property DamageCollection Case-Seller PlaintiffEnforcement of JudgmentAsbestos Personal Injury/Other Promissory Note/CollectionsEnforcement of Judgment (20)Wrongful DeathCaseAbstract of Judgment (Out ofProduct Liability (not asbestos orInsurance Coverage (not provisionallyCounty)toxic/environmental) (24)complex) (18)Confession of Judgment (non-Medical Malpractice (45)Auto Subrogationdomestic relations)Medical Malpractice-Other CoverageSister State JudgmentPhysicians & SurgeonsOther Contract (37)Administrative Agency AwardOther Professional Health CareContractual Fraud(not unpaid taxes)

10 MalpracticeOther Contract DisputePetition/Certification of Entry ofOther PI/PD /WD (23)Real PropertyJudgment on Unpaid TaxesPremises Liability ( , slipEminent Domain/InverseOther Enforcement of Judgmentand fall)Condemnation (14)CaseIntentional Bodily Injury/PD/WDWrongful Eviction (33)Miscellaneous Civil Complaint ( , assault, vandalism)Other Real Property ( , quiet title) (26)RICO (27)Intentional Infliction ofWrit of Possession of Real PropertyOther Complaint (not specifiedEmotional DistressMortgage Foreclosureabove) (42)Negligent Infliction ofQuiet TitleDeclaratory Relief OnlyEmotional DistressOther Real Property (not eminentInjunctive Relief Only (non-Other PI/PD /WDdomain, landlord/tenant, orharassment)Non- PI/PD /WD (Other) Tortforeclosure)Mechanics LienBusiness tort /Unfair BusinessUnlawful DetainerOther Commercial ComplaintPractice (07)Commercial (31)Case (non- tort /non-complex)Civil Rights ( , discrimination,Residential (32)Other Civil Complaintfalse arrest) (not civilDrugs (38) (if the case involves illegal(non- tort /non-complex)harassment) (08)drugs, check this item.)