PIERCE COUNTY SUPERIOR COURT, STATE OF WASHINGTON ________________________________________ ________________________________________ Plaintiff(s), vs. ________________________________________ ________________________________________ Defendant(s). CASE CATEGORY: COL Commercial/Contract _________ CONS Construction _________ DIS Family Law _________ PLAINTIFF'S ATTORNEY: NAME ADDRESS PHONE NAME ADDRESS ) ) ) ) ) ) ) ) ) ) ) Case No. __________________________ NOTE FOR ARBITRATION PIN Personal Injury ________ COM Real Estate ________ OTHER (Specify) ________ DEFENDANT'S ATTORNEY: PHONE (Please note additional attorneys on an attached page) [] ____________________________WSB#________ _________________________________________ _________________________________________ _________________________________________ ____________________________WSB#________ _________________________________________ _________________________________________ _________________________________________ STATEMENT OF ARBITRABILITY This case is subject to arbitration because the sole relief sought is a money judgment and involves no claim on excess of Fifty Thousand Dollars ($50,000), exclusive of attorney fees, interest and costs. This case is not subject to mandatory arbitration because: [ ] Plaintiff's claim exceeds Fifty Thousand Dollars ($50,000). [ ] Plaintiff seeks relief other than a money judgment. [ ] Defendant's counter or cross claim exceeds Fifty Thousand Dollars ($50,000). [ ] Defendant's counter or cross claim seeks relief other than a money judgment. The undersigned contends that its claim exceeds Fifty Thousand Dollars ($50,000). But hereby waives any claim in excess of Fifty Thousand Dollars for the purpose of arbitration. WSB# _____________ [] [] Signed ______________________________________________________ You may obtain additional copies of this form or use the interactive forms from our Web site at WWW.CO.PIERCE.WA.US/LINX/ Arbit\Arbnote08-2005.doc American LegalNet, Inc. www.FormsWorkflow.com