Please use this form to dismiss your claim if it is settled before the hearing date. Return this form to the Court. Short Title: Case Number: _____________________ vs. ______________________ Hearing Date: Time: Dept: _________________________________ ______/______/______ ______ _______ REQUEST FOR DISMISSAL TO THE CLERK: Please dismiss (check one box): Entire Action Plaintiff's Claim Only Defendant's Claim Only as follows (check one box): WITH PREJUDICE (You cannot sue the same defendant again for the same cause of action.) WITHOUT PREJUDICE (You may sue again on the same cause of action.) Dated: _______________ ____________________________________ Signature of Plaintiff Print Name: ______________________________ If a Defendant's Claim has been filed, the Defendant must also sign to dismiss the entire action. Dated: ________________ ______________________________________ Signature of Defendant Print Name: ____________________________________ REQUEST FOR DISMISSAL Small Claims Instructions April 11, 2008 American LegalNet, Inc. www.FormsWorkFlow.com