ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): Telephone No.: E-Mail Address (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY Fax No. (Optional): Bar No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: G Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 G Harbor-Laguna Hills Facility - 23141 Moulton Pkwy., Laguna Hills, CA 92653-1251 G Harbor-Newport Beach Facility - 4601 Jamboree Rd., Newport Beach, CA 92660-2595 G North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 G West - 8141 13th Street, Westminster, CA 92683-4593 PLAINTIFF: DEFENDANT: CASE NUMBER: SMALL CLAIMS APPEAL- REQUEST FOR DISMISSAL G Appellant(s) request the appeal in this case be dismissed. The original judgment/ruling will remain. (DATE) G (PRINT OR TYPE NAME) (SIGNATURE OF APPELLANT(S)) Appellant(s) and Respondent(s) stipulate to the dismissal of the appeal in this case. judgment/ruling will remain. (Both parties must sign if so stipulated.) The original (DATE) (PRINT OR TYPE NAME) (SIGNATURE OF APPELLANT(S)) (DATE) (PRINT OR TYPE NAME) (SIGNATURE OF RESPONDENT(S)) ................................................................................................................................................................................ (To be completed by the Clerk) G Dismissal of the Small Claims Appeal entered as requested. Small Claims Appeal hearing/trial date off calendar. Original judgment/ruling to remain. ALAN SLATER, Clerk of the Court Date: By: Deputy Clerk CLERK'S CERTIFICATE OF MAILING I certify that I am not a party to this action and that this certificate was mailed in accordance with Section 1013a of the Code of Civil Procedure. A copy of this Request for Dismissal was deposited in the United States mail, in a sealed envelope with postage fully , prepaid addressed as shown above. The mailing and this certification occurred at (place): California, ALAN SLATER, Clerk of the Court on (date): . By: Deputy Clerk Approved for Optional Use L543 (Rev. July 1, 2005) SMALL CLAIMS APPEAL - REQUEST FOR DISMISSAL Code of Civil Procedure, § 116.795 California Rules of Court, rule 155 American LegalNet, Inc. www.USCourtForms.com