Plaintiff (list names):
Case Number (for clerk):
One.
The Plaintiff (the person, business, or public entity that is suing) is:
Name:Chelsey Boeckmans
Phone:469965
Street Address (Street, City, State, Zip): Glenpark , appartementsblock
Mailing Address (if different):
If more than one Plaintiff, list next Plaintiff here:
Name:
Phone:
Street Address (Street, City, State, Zip):
Mailing Address (if different):
Two.
The Defendant (the person, business, or public entity being sued) is:
Name:Hugh Brong
Phone:/
Street Address (Street, City, State, Zip):/
Mailing Address (if different):
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 estimated by court
Why does the Defendant owe the Plaintiff money? He told infront of a cruisers dashbord camera he would rape me , he would make a porn video with me . So I am having trauma's and it was in public so it was public humilation, my honor and pride is gone, they call me a hooker, reputation is gone
When did this happen? (Date): 5/09/2013
If no specific date, give the time period: Date started: INSERT HERE Through: INSERT HERE
How did you calculate the money owed to you? (Do not include the court costs or fees for services.) INSERT HERE
/
Four.
List the evidence you have regarding the claims listed in three.
Evidence 4.1
Detail the items/pictures name DashBoard camera in cruiser , my brother Harry Willson
The actual evidence Dashboard camera.
Description of the evidence presented.
Evidence List Two EXPLAIN HERE Dashboard camera, court camera , Harry Willson
Detail the items/pictures name
The actual evidence
Description of the evidence presented.
Five.
You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue. Have you done this?
[ ] 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: 6/09/2013 Chelsey Boeckmans
Date: INSERT 2ND PLAINTIFFS NAME 2ND PLAINTIFFS NAME
Case Number (for clerk):
One.
The Plaintiff (the person, business, or public entity that is suing) is:
Name:Chelsey Boeckmans
Phone:469965
Street Address (Street, City, State, Zip): Glenpark , appartementsblock
Mailing Address (if different):
If more than one Plaintiff, list next Plaintiff here:
Name:
Phone:
Street Address (Street, City, State, Zip):
Mailing Address (if different):
Two.
The Defendant (the person, business, or public entity being sued) is:
Name:Hugh Brong
Phone:/
Street Address (Street, City, State, Zip):/
Mailing Address (if different):
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 estimated by court
Why does the Defendant owe the Plaintiff money? He told infront of a cruisers dashbord camera he would rape me , he would make a porn video with me . So I am having trauma's and it was in public so it was public humilation, my honor and pride is gone, they call me a hooker, reputation is gone
When did this happen? (Date): 5/09/2013
If no specific date, give the time period: Date started: INSERT HERE Through: INSERT HERE
How did you calculate the money owed to you? (Do not include the court costs or fees for services.) INSERT HERE
/
Four.
List the evidence you have regarding the claims listed in three.
Evidence 4.1
Detail the items/pictures name DashBoard camera in cruiser , my brother Harry Willson
The actual evidence Dashboard camera.
Description of the evidence presented.
Evidence List Two EXPLAIN HERE Dashboard camera, court camera , Harry Willson
Detail the items/pictures name
The actual evidence
Description of the evidence presented.
Five.
You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue. Have you done this?
[ ] 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: 6/09/2013 Chelsey Boeckmans
Date: INSERT 2ND PLAINTIFFS NAME 2ND PLAINTIFFS NAME
