SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE RIVERSIDE 4050 Main St., Riverside, CA 92501 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) FOR COURT USE ONLY RI-ADR13 TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PLAINTIFF: DEFENDANT: Hearing Date: Time: CASE NUMBER: Department: COLLECTIONS MANDATORY SETTLEMENT CONFERENCE STATEMENT CRC Rule 3.1380(c) DO NOT FILE You must complete this form and bring it and all supporting evidence to your Mandatory Settlement Conference. Plaintiffs: If you fail to comply, the court may dismiss your complaint and impose monetary sanctions. Defendants: If you fail to comply, the court may strike your answer and impose monetary sanctions. These papers will only be used during the Mandatory Settlement Conference to discuss settlement options. They do not become part of the court file and they are not given to the opposing party without your consent. READ THE ENTIRE FORM BEFORE YOU START WRITING . DEFENDANTS: GO TO NUMBER 3 1. PLAINTIFF'S STATEMENT OF FACTS a. Type of Case (for example, credit card debt, car loan, department store debt etc.): b. Breakdown of Debt Alleged: Principal: $ Accrued Interest: $ Interest Rate (APR): Other (fees/costs): $ Total payments to date: $ Date of last payment: Total amount owed to date (balance due): Additional facts: % Amount of last payment: $ $ c. Page 1 of 3 Approved for Mandatory Use Riverside Superior Court RI-ADR13 [Rev.10/4/11] COLLECTIONS MANDATORY SETTLEMENT CONFERENCE STATEMENT CRC Rule 3.1380(c) riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: 2. PLAINTIFF'S SETTLEMENT PROPOSALS: is willing is not willing to accept a reduced amount to settle this case. State amount, percentage a. Plaintiff or range: $ . b. (i) (ii) Installment Payments is willing Plaintiff payment. Plaintiff is willing is not willing to accept installment payments with or without a lump sum is not willing to accept installment payments only with a lump sum payment. State proposed amounts, if possible: If there is a lump sum payment of $ payments of $ per by week month (date) plaintiff will accept installment other If there is no lump sum payment, plaintiff will accept installment payments of $ per week month other c. Plaintiff interest of $ is willing . not willing to waive costs of $ attorney's fees of $ d. Plaintiff is willing ex-parte declaration. GO TO QUESTION 5 not willing to enter into a stipulation for entry of judgment upon default, on 3. DEFENDANT'S STATEMENT OF FACTS: a. Type of Case (for example, credit card debt, car loan, department store debt, etc.): b. c. (i) (ii) (iii) I filed for Bankruptcy on (date): I do not owe the amount claimed in the Complaint. This is not my account. (Explain): The account has been paid in full. Last payment date: Case Number: Amount: $ Date: Dates The account has been partially paid. Total amount paid $ $ $ $ Payments d. Additional facts: Approved for Mandatory Use Riverside Superior Court RI-ADR13 [Rev. 10/4/11] COLLECTIONS MANDATORY SETTLEMENT CONFERENCE STATEMENT CRC Rule 3.1380(c) riverside.courts.ca.gov/localfrms/localfrms.shtml Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: 4. DEFENDANT'S SETTLEMENT PROPOSALS: a I am willing to pay this amount $ I can pay this amount by this date: I can make installment payments in the amount of (specify): $ per week month I can make a lump sum payment of $ to fully resolve this case. other By (date): . b. c. I am not able to pay any money to resolve this case. Other settlement proposals: QUESTIONS 5, 6 AND 7 ARE FOR BOTH PLAINTIFFS AND DEFENDANTS: 5. Previous Settlement Attempts: (Describe past settlement discussions, including demands and offers.) 6. Additional information about this case: 7. PLAINTIFFS AND DEFENDANTS MUST BRING WRITTEN EVIDENCE TO THE MANDATORY SETTLEMENT CONFERENCE I will bring the following written proof of the facts stated above to the Mandatory Settlement Conference. The contract The most recent outstanding statement Billing statements Credit card statements Cancelled checks Receipts Letters/e-mails Other: Defendants must also bring: Collections MSC Financial Worksheet Attachment (Local Form #RI-ADR13-A). Written evidence of your financial situation (for example, paystubs, proof of Social Security, SSI, or unemployment benefits). I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) Approved for Mandatoryl Use Riverside Superior Court RI-ADR13 [Rev. 10/4/11] COLLECTIONS MANDATORY SETTLEMENT CONFERENCE STATEMENT CRC Rule 3.1380(c) riverside.courts.ca.gov/localfrms/localfrms.shtml Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com