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Court Mandated Interrogatories Form. This is a California form and can be use in Humboldt Local County.
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Tags: Court Mandated Interrogatories, California Local County, Humboldt
Attorney or Party Without Attorney:
(Name, Address and State Bar Number)
Phone Number:
Attorney for (Name):
SUPERIOR COURT OF CALIFORNIA
COUNTY OF HUMBOLDT
_________________________________,
Plaintiff(s),
vs.
_________________________________,
Defendant(s)
)
)
)
)
)
)
)
)
)
)
Case No.: ______________________
COURT MANDATED INTERROGATORIES
(To Be Answered by Defendant/CrossDefendant)
IDENTITY OF PERSONS ANSWERING THESE INTERROGATORIES
INTERROGATORY NO. 1.1:
State the name, ADDRESS, telephone number, and relationship to you of each PERSON
who prepared or assisted in the preparation of the responses to these interrogatories. (Do not
identify anyone who simply typed or reproduced the responses.)
GENERAL BACKGROUND INFORMATION – INDIVIDUAL
INTERROGATORY NO. 2.1:
State:
(a)
Your name;
(b)
Every name you have used in the past;
(c)
The dates you used each name.
Eff. 07/01/1994; as amended, eff. 07/01/2010 – Mandatory Form
Humboldt County Local Rule 2.7.3
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INTERROGATORY NO. 2.2:
State the date and place of your birth.
INTERROGATORY NO. 2.3:
If this INCIDENT involves an auto accident and you were a driver, did you have a
driver's license? If so, state:
(a) The state or other issuing entity;
(b) The license number and type;
(c) The date of issuance;
(d) All restrictions.
INTERROGATORY NO. 2.4:
State:
(a)
Your present residence ADDRESS;
(b)
Your residence ADDRESSES for the last five years;
(c)
The dates you lived at each ADDRESS.
INTERROGATORY NO. 2.5:
State:
(a)
The name, ADDRESS, and telephone number of your present employer or place
of self-employment;
(b)
The name, ADDRESSES, dates of employment, job title, and nature of work for
each employer or self-employment you have had from five years before the
INCIDENT until today.
INTERROGATORY NO. 2.6:
State:
(a)
The name and ADDRESS of each school or other academic or vocational
institution you have attended beginning with high school;
(b)
The dates you attended;
(c)
The highest grade level you have completed;
(d)
The degrees received.
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
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INTERROGATORY NO. 2.7:
Have you ever been convicted of a felony? If so, for each conviction state:
(a)
The city and state where you were convicted;
(b)
The date of conviction;
(c)
The offense;
(d)
The Court and case number.
INTERROGATORY NO. 2.8:
Can you speak English with ease? If not, what language and dialect do you normally use?
INTERROGATORY NO. 2.9:
Can you read and write English with ease? If not, what language and dialect do you
normally use?
INTERROGATORY NO. 2.10:
At the time of the INCIDENT were you acting as an agent or employee for any
PERSON? If so, state:
(a)
The name, ADDRESS, and telephone number of that PERSON;
(b)
Description of your duties.
INTERROGATORY NO. 2.11:
At the time of the INCIDENT did you or any other person have any physical, emotional,
or mental disability or condition that may have contributed to the occurrence of the INCIDENT?
If so, for each person state:
(a)
The name, ADDRESS, and telephone number;
(b)
The nature of the disability or condition;
(c)
The manner in which the disability or condition contributed to the occurrence of
the INCIDENT.
INTERROGATORY NO. 2.12:
Within 24 hours before the INCIDENT did you or any person involved in the
INCIDENT use or take any of the following substances: alcoholic beverages, marijuana, or
other drug or medication of any kind (prescription or not)? If so, for each person state:
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
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(a)
The name, ADDRESS, and telephone number;
(b)
The nature of the description of each substance;
(c)
The quantity of each substance used or taken;
(d)
The date and time of day when each substance was used or taken;
(e)
The ADDRESS where each substance was used or taken;
(f)
The name, ADDRESS, and telephone number of each person who was present
when each substance was used or taken;
(g)
The name, ADDRESS, and telephone number of any HEALTH CARE
PROVIDER that prescribed or furnished the substance and the condition for
which it was prescribed or furnished.
GENERAL BACKGROUND INFORMATION - - BUSINESS ENTITY
INTERROGATORY NO. 3.1:
Are you a corporation? If so, state:
(a)
The name stated in the current articles of incorporation;
(b)
All other business names used by the corporation during the past ten years;
(c)
The date and place of incorporation;
(d)
The ADDRESS of the principal place of business;
(e)
Whether you are qualified to do business in California.
INTERROGATORY NO. 3.2:
Are you a partnership? If so, state:
(a)
The current partnership name;
(b)
All other names used by the partnership during the past ten years and dates each
was used;
(c)
Whether you are a limited partnership and, if so, under the laws of what
jurisdiction;
(d)
The name and ADDRESS of each general partner;
(e)
The ADDRESS of the principal place of business.
, Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
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www.FormsWorkFlow.com
INTERROGATORY NO. 3.3:
Are you a joint venture? If so, state:
(a)
The current joint venture name;
(b)
All other names used by the joint venture during the past ten years and the dates
each was used;
(c)
The name and ADDRESS of each joint venturer;
(d)
The ADDRESS of the principal place of business.
INTERROGATORY NO. 3.4:
Are you an unincorporated association? If so, state:
(a)
The current unincorporated association name;
(b)
All other names used by the unincorporated association during the past ten years
and the dates each was used;
(c)
The ADDRESS of the principal place of business.
INTERROGATORY NO. 3.5:
Have you done business under a fictitious name during the past ten years? If so, for each
fictitious name state:
(a)
The name;
(b)
The dates each was used;
(c)
The state and county of each fictitious name filing;
(d)
The ADDRESS of the principal place of business.
INTERROGATORY NO. 3.6:
If you are a business entity not identified above, please:
(a)
Describe the kind or nature of the entity;
(b)
Identify all the names under which the entity does business; and
(c)
Identify the address of the principal place of business.
INSURANCE
INTERROGATORY NO. 4.1:
At the time of the INCIDENT, was there in effect any policy of insurance through which
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
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www.FormsWorkFlow.com
you were or might be insured in any manner (for example, primary, pro-rata, or excess liability
coverage or medical expense coverage) for the damages, claims, or actions that have arisen out
of the INCIDENT? If so, for each policy state:
(a)
The kind of coverage;
(b)
The name and ADDRESS of the insurance company;
(c)
The name, ADDRESS, and telephone number of each named insured;
(d)
The policy number;
(e)
The limits of coverage for each type of coverage contained in the policy;
(f)
Whether any reservation of rights or controversy or coverage dispute exists
between you and the insurance company and the basis for such reservation,
controversy or dispute.
INTERROGATORY NO. 4.2:
Are you self-insured under any statute for the damages, claims, or actions that have arisen
out of the INDECENT? If so, specify the statute.
INVESTIGATION - GENERAL
INTERROGATORY NO. 5.1:
State the name, ADDRESS, and telephone number of each individual who you believe:
(a)
Witnessed the INCIDENT or the events occurring immediately before or after
the INCIDENT;
(b)
Made any statement at the scene of the INCIDENT;
(c)
Heard any statements made about the INCIDENT by any individual at the scene;
(d)
Has knowledge of the INCIDENT, including a short description of the
knowledge they have (except for expert witnesses covered by Code of Civil
Procedure §2034.210).
INTERROGATORY NO. 5.2:
Do YOU OR ANYONE ACTING ON YOUR BEHALF know of any photographs,
films, or videotapes depicting any place, object, or individual concerning the INCIDENT or
plaintiff’s injuries? If so, state:
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
American LegalNet, Inc.
www.FormsWorkFlow.com
(a)
The number of photographs or feet of film or videotape;
(b)
The places, objects, or persons photographed, filmed, or videotaped;
(c)
The date the photographs, films, or videotapes were taken;
(d)
The name, ADDRESS, and telephone number of the individual taking the
photographs, films, or videotapes;
(e)
The name, ADDRESS, and telephone number of each PERSON who has the
original or a copy.
INTERROGATORY NO. 5.3:
Do YOU OR ANYONE ACTING ON YOUR BEHALF know of any diagram,
reproduction, or model of any place or thing (except for items developed by expert witnesses
covered by Code of Civil Procedure §2034.210) concerning the INCIDENT: If so, for each item
state:
(a)
The type (i.e., diagram, reproduction, or model);
(b)
The subject matter;
(c)
The name, ADDRESS, and telephone number of each PERSON who has it.
INTERROGATORY NO. 5.4:
Was a report made by any PERSON concerning the INCIDENT? If so, state:
(a)
The name, title, identification number, and employer for the PERSON who made
the report;
(b)
The date and type of report made;
(c)
The name, ADDRESS, and telephone number of the PERSON for whom the
report was made.
DEFENDANT’S CONTENTIONS – PERSONAL INJURY
INTERROGATORY NO. 6.1:
Do you contend that any PERSON, other than you or plaintiff, contributed to the
occurrence of the INCIDENT or the injuries or damages claimed by plaintiff? If so, for each
PERSON:
(a)
State the name, ADDRESS, and telephone number of the PERSON;
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
American LegalNet, Inc.
www.FormsWorkFlow.com
(b)
State all facts upon which you base your contention;
(c)
State the name, ADDRESS, and telephone numbers of all PERSONS who have
knowledge of the facts;
(d)
Identify all DOCUMENTS and other tangible things that support your contention
and state the name, ADDRESS, and telephone number of the PERSON who has
each DOCUMENT or thing.
VERIFICATION
I, the undersigned, say:
I am: a special agent; an officer; a partner; a party; other _____________________
in the above-entitled action. I have read the foregoing Responses to COURT MANDATED
INTERROGATORIES and know the contents thereof and I do certify under penalty of perjury
under the laws of the State of California that the foregoing is true and correct; except as to those
matters stated on information or belief, and as to those matters, I believe it to be true.
Executed on _________________________, at______________________, California.
________________________________
______________________________
Type or Print Name
Signature
Eff. 07/01/1994; as amended, eff. 07/01/2010
Humboldt County Local Rule 2.7.3
American LegalNet, Inc.
www.FormsWorkFlow.com
