ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): MARIN COUNTY SUPERIOR COURT 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: CASE NUMBER: STIPULATION & ORDER TO DISMISS ACTION AND SUBMIT CAUSES OF ACTION TO SMALL CLAIMS JURISDICTION The parties to the above referenced action hereby agree and stipulate as follows: this case, including any cross-complaint, shall be dismissed with prejudice with the exception that any causes of action, including cross-actions, and/or defenses thereto, shall be preserved and submitted, to the jurisdiction of the Small Claims division. Each party waives the service of process of the small claims or cross-claim form which shall be completed and filed with the Clerk. Statutory costs of suit, including attorney fees, incurred by the parties shall not be recoverable in any Small Claims judgment. The judicial officer to whom the Small Claims action is assigned shall take judicial notice of the aboveentitled action. Neither party shall be required to pay a Small Claims filing fee and any filing fees already paid to the Clerk shall not be refunded as a result of the stipulation. A party against whom a small claims money judgment is rendered may file a notice of appeal for a trial de novo upon payment of the appropriate filing fees. DATE PETITIONER/PLAINTIFF DATE RESPONDENT/DEFENDANT ORDER SO ORDERED: DATE JUDICIAL OFFICER OF THE SUPERIOR COURT CV032 STIPULATION & ORDER TO DISMISS ACTION AND SUBMIT CAUSES OF ACTION TO SMALL CLAIMS JURISDICTION Rev. 5/29/15 American LegalNet, Inc. www.FormsWorkFlow.com