Mittell "Shaggy" Buurman
New Member
Ninth Judicial Circuit
"Equal Justice Under Law"
SC-100
Plaintiff (list names): Mittell Buurman, Chelsea Curtis
Case Number (for clerk):
One.
The Plaintiff (the person, business, or public entity that is suing) is:
Name: Mittell Buurman
Phone: 780540
Street Address (Street, City, State, Zip): 6 Palin Street, San Andreas, RM92019
Mailing Address (if different):
If more than one Plaintiff, list next Plaintiff here:
Name: Chelsea Curtis
Phone: 734837
Street Address (Street, City, State, Zip): 6 Palin Street, San Andreas, RM92019
Mailing Address (if different):
Two.
The Defendant (the person, business, or public entity being sued) is:
Name: Amanda Wood
Phone: 396082
Street Address (Street, City, State, Zip): Unknown
Mailing Address (if different): Unknown
If more than one Defendant, list next Defendant here:
Name:
Phone:
Street Address (Street, City, State, Zip):
Mailing Address (if different):
Three.
The Plaintiff claims the Defendant owes $15.000
[*=left]Why does the Defendant owe the Plaintiff money? Medical bills(bone replacement,surgery), Damage of property, sexual harrassment, 2x assault.
[*=left]When did this happen? (Date): 26/08/2013 & 28/08/2013
[*=left]If no specific date, give the time period: Date started: INSERT HERE Through: INSERT HERE
Four.
You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue. Have you done this?
[*=left][ ] Yes ---------- [X] No
Five.I understand that by filing a claim in small claims court, I have no right to appeal this claim.
I declare, under penalty of perjury under California State law, that the information above and on any attachments to this form is true and correct.
Date: 29/08/2013 Mittell Buurman M.Buurman
Date: 29/08/2013 Chelsea Curtis C.Curtis