AT ISSUE MEMORANDUM Name, Address & Telephone No. of Attorney or Party Appearing without Attorney. COURT USE ONLY Attorney(s) For: SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE ONE COURT STREET - OROVILLE, CALIFORNIA 95965 Plaintiff / Petitioner: VS. Defendant / Respondent: CASE NUMBER: AT ISSUE MEMORANDUM COUNTER AT ISSUE 1, Nature of case: Personal Injury, Property Damage or Wrongful Death 2. Date of Prior At-lssue: Motor Vehicle Other 3. Time Estimate for Trial: Domestic Relations I Family Law Eminent Domain; 4. Jury Trial Requested: Yes NO 5. Complaint Date Other: (specify): 6. Is Case entitled to preference? Days Hours No Yes, under Code 7. Does the amount in controversy exceed $50,000 as to soy Plaintiff? Yes No 8. Are the parties claiming an exemption from mandatory arbitration pursuant to CRC 1600.5? Yes No 9. If you are counsel for plaintiff and are not claiming exemption, do you elect to refer the matter to Arbitration? Yes No 10. If you are plaintiff's counsel and do not elect Arbitration, do you object to Arbitration being ordered? Yes No 11. If Personal Injury: e. Nature and extent of injuries b. Total medical expenses to date: c. Future medical expenses: d. Loss of earnings to date: e. Future loss of earnings: f. Other special or general damages Indicate party being represented: Plaintiff / Petitioner: Attorney: Firm: Address: Defendant / Respondent: Attorney: Firm: Address: Telephone No.: Telephone No.: Plaintiff / Petitioner: Attorney: Firm: Address: Defendant / Respondent Attorney: Firm: Address: Telephone No.: Telephone No.: For additional parties, please attach a separate sheet. See reverse side for certificate of mailing. (RUL 7-MA.010) Page 1 of 2 (A.D. 7-1-93) 2000 (C) American LegalNet, Inc. BUTTE COUNTY SUPERIOR COURT RULES I hereby represent to the Court that all essential parties have been served with process or have appeared herein and that this case is at issue as to all such parties; that no amended or supplemental complaint or cross-complaint or other affirmative pleading remains unanswered; that to my knowledge no other parties will be served with a summons prior to the time of trial, and I know of no further pleading to be filed. Date: , 20 Attorney(s) for: Any party not in agreement with the information or estimates given in an at-issue memorandum shall within ten days after service thereof serve and file a memorandum in his behalf. (PROOF OF SERVICE BY MAIL -- 1013(a) §2015.5 CCP) I am a citizen of the United States and a resident of the county of of eighteen years and not a party to the within entitled action; my residence / business address is: On on the , 20 . I am over the age , I served the within in said action, by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully prepaid, in the United States post office mail box at addressed as follows: DECLARATION I declare under penalty of perjury, under the laws of the State of California, that the foregoing, including any attachment, is true and correct and that this declaration is executed on (date): at (place): . [Type or print name] (RUL-7-MA-010) [Signature of Declarant] Page 2 of 2 (A.D. 7-1-93) 2000 (C) American LegalNet, Inc.