IOri?

Lisa Bloom, Esq. (SBN 158458)

Lynne Brennan, Esq. (SBN 149131)

Yisha Fan, Esq. (SBN 314640)
THE BLOOM FIRM

20700 Ventura Blvd., Suite 301
Woodland Hills, CA 91364
Telephone: (818) 914-7 3 22
Facsimile: (866) 852-5666

Email: Lynne@TheBloomFirm.com

Attorneys for Plaintiff
JANE DOE

 

SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF LOS ANGELES, CENTRAL DIVISION

. JANE DOE,

Plaintiff.
v.

JOHN DOE,

Defendant.

 

 

COMPLAINT FOR DAMAGES

30703984

CASE NO.:

COMPLAINT FOR 

1. SEXUAL BATTERY IN VIOLATION
OF CAL. CIV. CODE 1708.5

2. COMMON LAW BATTERY

3. SEXUAL ASSAULT

4. INTENTIONAL INFLICTION OF
EMOTIONAL DISTRESS

PURSUANT To C.C.P. 340.1]

A CERTIFICATES OF MERIT REQUIRED

BY C.C.P. 340.1(g) and LODGED
CONCURRENTLY HEREWITH IN 
CAMERA REVIEW REQUESTED
PURSUANT To C.C.P. 340.10)

DEMAND FOR JURY TRIAL

 


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Plaintiff JANE DOE, by and through undersigned counsel The Bloom Firm, brings the

instant action against Defendant JOHN DOE and alleges as follows:
PARTIES 

1. Plaintiff JANE DOE Doe?) is, and at all times herein mentioned was, an
individual residing in the County of Los Angeles. The incident of childhood sexual abuse
described herein took place when Ms. Doe was sixteen years old.

2. Defendant JOHN DOE is, and was at all times herein mentioned, an individual
residing in the County of Los Angeles. Mr. Doe was in his early forties at the time of the
incident. I i


. 3. Venue is proper in Los Angeles County because the Defendant conducts business as
an elected politician in Los Angeles County. Additionally, the events, conduct, and injuries
occurred in Los Angeles County.
. ALLEGATIONS

4. Ms. Doe ?rst met Mr. Doe in early 2005 at a golf tournament when she was just
fourteen years old. At that time, Mr. Doe was an elected politician in Los Angeles and Ms. Doe
was a star teenage athlete. Shortly thereafter, Mr. Doe grew close to and became an integral
part of Ms. Doe?s and her family?s lives.

5. On January 29, 2007, when Ms. Doe was sixteen years old, Mr. Doe invited Ms. Doc
to play golf at Hillcrest Country Club. Several hours into their game, Mr. Doe handed Ms. Doe 
a cup of ice water. Ms. Doe did not know where he got the water but recalled that it tasted
different from both tap and ?ltered water and different from water that Mr.
Doe had given to Ms. Doe during their prior golf outings. Because of its peculiar taste, she
ceased to drink it after a few sips. The two had played golf for approximately four to ?ve hours
when Ms. Doe suddenly collapsed to the ground but did not lose consciousness.

6. Mr. Doe took it upon himself to drive Ms. Doc to the emergency room. Ms. Doe sat
in the passenger seat of Mr. Doe?s car with her eyes closed and her head resting on the

passenger side window, though she was not asleep. Mr. Doe reached his hands inside Ms.

1
COMPLAINT FOR DAMAGES

 

Doe?s shirt and rubbed her breasts. Mr. Doe then reached down her shorts and fondled her
vagina. Ms. Doe was ?'ozen from shock.

Mr. Doe continued to touch Ms. Doe?s breasts and vagina intermittently throughout
the drive to the hospital. ,Ms. Doe remained motionless and speechless throughout the entire
incident in fear of what he might do if she did not feign sleep.

8. Mr. Doe left irmnediately a?er dropping off Ms. Doe at the hospital.

9. For the next year and a half, she distracted herself through school and sports and tried
her best to act normally around her family and Mr. Doe so as not to arouse suspicion. However,
she began to fear Mr. Doe and avoided being alone with him. And while she tried her best to
maintain her practice regimen, she soon discovered that it triggered memories of her sexual
assault. As a result, she ceased playing golf with the same frequency and fervor as before.

10. Ms. Doe never confronted Mr. Doe about the abuse. She did not report the incident
to the police, fearing she would not be believed, or that Mr. Doe would retaliate against her or
her family.

11. However, on one occasion after the abuse, Ms. Doe found herself alone with Mr.
Doe at her father?s work place. Mr. Doe told a joke, but she failed to laugh at it. In response,
Mr. Doe told her, ?Remember where your dad works.? She perceived that as a threat against
her family?s security. .

12. Soon after Ms. Doe began her freshman year at a California university on a golf
scholarship, Ms. Doe pushed memories of the incident even further deep down and tried her

best to cope. Ms. Doe internalized feelings of shame and self-blame as a result of Mr. Doe?s

. abuse and dissociated from those feelings. During this time, Ms. Doe became withdrawn and

felt isolated. Her grades and her performance in golf tournaments suffered as a result. For the
?rst time, she was placed on academic probation. During her second semester in college, she
withdrew. Soon after withdrawing from college, she ceased playing golf altogether.

13. After getting married and becoming pregnant with her daughter in 2017, Ms. Doe
began to relive her nightmare of being sexually assaulted by Mr. Doe. She was haunted by__

everything she wished she had done differently. She regretted not reporting it to the authorities.

2
COMPLAINT FOR DAMAGES

 




00 -b 03 00 



 

 

She regretted not putting a stop to it. She regretted not ?ghting back. She began to recall other
incidents where Mr. Doe touched her arm or her leg without her express consent. She felt
powerless and blamed herself for what happened. Ms. Doe ?nally made the connection
between her injuries and Mr. Doe?s abuse when she became pregnant with her
daughter in 2017.

14. Ms. Doe made the decision to con?de in her ?anc?e about the incident in December
2017 and January 2018. Being pregnant with a baby girl and encouraged by the brave women
coming forward in the #MeToo movement, Ms. Dee realized that she could no longer hide or
bury the truth of the sexual abuse she had suffered. She wanted to show her daughter that she
can be strong and that what happened to her was not okay. Ms. Doe never, ever wanted her
daughter to go through this, but if she did, Ms. Doe wanted to be a strong role model for her.
That meant Ms. Doe was ?nally going to speak up about the sexual abuse she suffered so she
can start the healing process. She also decided to speak up in hopes that it would diminish the
occurrence of sexual abuse so that her daughter would not have to suffer similar experiences in
the future.

15. Ms. Doe continues to suffer because of the incident and currently attends therapy.

CHILDHOOD SEXUAL ABUSE GOVERNED BY C.C.P. SECTION 340.1
16. Ms. Doe restates and incorporates by reference, as though fully set forth herein, the

allegations contained in each of the paragraphs above. 

17. Ms. Doe was under the age of 18 years when Mr. Doe fondled her breasts and
vagina as he transported her in his car to the emergency room. Mr. Doe? 5 acts constitute

?childhood sexual abuse? as de?ned 1n C. C. P. section 340.1(e) by violating the California Penal

Code, including but not limited to, Penal Code, section 289(h).

18. Ms. Doe brings this action against Mr. Doe within three years of the date she .
discovered or reasonably should have discovered that injury or illness occurring
after the age of majority was caused by the sexual abuse. I Therefore, this complaint is timely

pursuant to C.C.P. section 340.1.

COMPLAINT OR DAMAGES

 

 

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00 \1 NO 00 A U.) 

 

 

CLAIMS FOR RELIEF

FIRST CAUSE OF ACTION
(SEXUAL BATTERY IN VIOLATION OF CALIFORNIA CIVIL CODE 1708.5)

19?. Ms. Doe restates and incorporates by reference, as though fully set forth herein, the
allegations contained in each of the paragraphs above.

20. Mr. Doe is a ?person? under California Civil Code 1708.5.

21. In fondling Ms. Doe?s breasts and vagina on several occasions while she was a
passenger in his car, Mr. Doe acted with the intent to and did make offensive contact with
intiniate parts of Ms. Doe.

22. Mr. Doe subjected Ms. Doe to nonconsensual1 and intentional invasions of her-right
to be free from sexually offensive contact. I

23. Ms. Doe was harmed and offended by Mr. Doe?s conduct as any. reasonable person
in her situation would have been.

24. As a direct and proximate result of Mr. Doe?s actions, Ms. Doe suffered special and
general damages, including physical pain, mental suffering, loss of enjoyment of life, anxiety,
humiliation, and emotional distress. Additionally, Ms. Doe suffered a loss of earnings and other
economic opportunities. .

25. Mr. Doe?s conduct was malicious and oppressive, and done with a conscious disregard of

Ms. Doe?s rights. Mr. Doe?s-Conduct is especially egregious because he was both a public

. ?gure and a trusted mentor to Ms. Doe, who at that time was only sixteen years old. Ms. Doe is

entitled to punitive damages from Mr. Doe in an amount to be determined at trial.
ill







 

?Moreover, under California Civil Code 1708.55, consent is not a defense in any civil action
under Section 1708.5 if the person who commits the sexual battery is an adult who is in a position
of authority over the minor.

COMPLAINT FOR DAMAGES

 


4:3?





Ci!






 

 

SECOND CAUSE OF ACTION
(COMMON LAW BATTERY)

26. Ms. Doe restates and incorporates by reference, as though fully set forth herein, the
allegations contained in each Of the paragraphs above.

27. In fondling Ms. Doe?s breasts and vagina on several occasions while she was a

passenger in his car, Mr. Doe acted with the intent to and did make offensive contact with

intimate parts of Ms. Doe.

28. Mr. Doe subjected Ms. Doc to nonconsensual and intentional invasions of her right I.
to be free from sexually offensive contact. 

29. Ms. Doe was harmed and offended by Mr. Doe?s conduct as any reasonable person
in her situation Would have been. i i

30. As a direct and proximate result of Mr. Doe?s actions, Ms. Doe suffered special and
general damages, including physical pain, mental suffering, loss of enjoyment of life, anxiety,
humiliation, and emotional distress. Additionally, Ms. Doe suffered a loss of earnings and other
economic opportunities.

3-1. Mr. Doe?s conduct was malicious and oppressive, and done with a conscious
disregard of Ms. Doe?s rights. Mr. Doe?s conduct is especially egregious where he was both a
public figure and a trusted mentor .to Ms. Doe, who at that time was'only sixteen years old. Ms.

Doe is entitled to punitive damages from Mr. Doe in an amount to be determined at trial.

THIRD CAUSE OF ACTION
(SEXUAL ASSAULT)
32. Ms. Doe restates and incorporates by reference, as though fully set forth herein, the
allegations contained in each of the paragraphs above.
33. During the 30. to 45 minutes where Ms. Doe endured Mr. Doe?s harmful and
Offensive touching, Ms. Doe had a reasonable apprehension of continued offensive and
immediate touching.

34. Ms. Doe did not consent to any of the aforementioned acts of Mr. Doe.



COMPLAINT FOR DAMAGES

 

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35. As a direct and proximate result of Mr. Doe?s actions, Ms. Doe suffered special and
general damages, including physical pain, mental suffering, loss of enjoyment of life, anxiety,
humiliation, and emotional distress. Additionally, Ms. Doe suffered a loss of earnings and other
economic opportunities. -

36. Mr. Doe?s conduct was malicious and oppressive, and done with a conscious
disregard of Ms. Doe?s rights. Mr. Doe?s conduct is especially egregious where he was both a
public ?gure and a trusted mentor to Ms. Doe, who. at that time was only sixteen years old. Ms.
Doe is entitled to punitive damages from Mr. Doe in an amount to be determined at trial.

I FOURTH CAUSE OF ACTION
(INTENTIONAL INFLICT ION 0F EMOTIONAL DISTRESS)

37. Ms. Doe restates and incorporates by reference, as though fully set forth herein, the
allegations contained in each of the paragraphs above.

38. As alleged herein, Mr. Doe engaged in outrageous conduct towards Ms. Doe, with
intention to cause, or with reckless disregard of the probability of causing Ms. Doe to suffer
Severe emotional and distress. -

39. As a direct and proximate result of Mr. Doe?s actions, 'Ms. Doe suffered special and
general damages, including physical pain, mental suffering, loss of enjoyment of life, anxiety, .
humiliation, and emotional distress. Additionally, Ms. Doe suffered a loss of earnings and other
economic opportunities.

40. Mr. Doe?s conduct was a substantial factor in causing Ms. Doe?s harm.

-41. Mr. Doe?s conduct was malicious and oppressive, and?done with a conscious

disregard of Ms. DOe?s rights. Mr. Doe?s conduct is especially egregious where he was both a

. public ?gure and a trusted mentor to Ms. Doe, who at that time was only sixteen years old. Ms.

'Doe is entitled to punitive damages from Mr. Doe in an amount to be determined at trial.





COMPLAINT FOR DAMAGES

 

rPRAYER FOR RELIEF
WHEREFORE, Plaintiff prays for judgment and damages against the Defendant as
follows:
1. General damages in an amount to be determined at trial;
. Past and future medical and related expenses in an amount to be determined at trial;

Past and future?lost earnings in an amount to be determined at trial;

. Punitive damages pursuant to applicable law;

2
3
4. Impairment of earning capacity in an amount to be determined at trial;
5 .
6. Reasonable attorneys? fees pursuant to applicable law;

7

. Prejudgment and post-judgment interest, including but not limited to, California
Civil Code 3288; and
8. Any other and further relief that the Court considers just and proper.

DEMAND FOR JURY TRIAL
Plaintiff hereby requests a trial by jury.

DATED: April 26, 2018 THE BLOOM FIRM

 

Lynne M. Bren?ay

Attorneys for Plaintiff JANE DOE

COMPLAINT FOR DAMAGES

 

Original

 

 

 

 

 

 

 

 

 

 

 

 

CM-O1O
. .. on PARTY WITHOUT anomawuom em Barnum, endaddrescji- son couaruscomr
Lgnne Brennan (SBN 149131)
Bloomji?irm
20700 Ventura Blvd. Suite 301
Woodland Hills, CA 91364
membership}; (818) 914-7361 mud-z;
anomev FOR {my ane Doe
supenron couar OF simmer-us. comm or Lo 8 Ange 1 
srasermoness 1 11 . Hill Street
MAILING mosses
cmmozrecooe:Los Angeles, CA 90012
anmcu NAME: Cent ra
CASE NAME: Jane Doe . John Doe
CIVIL CASE COVER SHEET Complex Case Designation case from (73:32: [3 Counter Jolnder
demanded demanded is Filed with first appearance by defendant 
exceeds $25,000) $25,000 or less) (Cal. Flules of Court. rule 3.402) ospr??
items 1-6 below must be completed (see instructions on page 2).
1. Check one below or the case type that best descnbest is case:
Auto Tort Contract Provisionally Complex Civil Litigation
Auto (22) Breach of contract/warranty (06) Cal. Ruies of Court. rutes 3.4004303)
Uninsured motorist (46) Rule 3.740 collections (09) Antitrustfirade regulation (03)
Oil PUPDIWD (Personal Other collections (09) Construction detect (10)
DamageIWrongfuI Death) Tort Insurance coverage (18) Mass tort (40)
Asbestos (04) Other contract (37) Siesta-tiles ?((2180)ft ?30)
. . ronmanta 0
amount ham? (2.4) Real . Insurance coverage claims arising from the
edlcal malpractice (45) Eminent domainilnverse above listed rovisionall com 1 
Other PiIPDiwo (23) condemnation (14) 9 9 
5th 7 Wrongful eviction (33) Mm 
arr-t; . ort_ . Other real property (26) Enforcement of Judgment
trainees tort/unfair busrness practice Enforcement of judgment (20)
Civil rights (08) Unlawful Detainer
Defamation (13) Commercial (31) Miscellaneous Civil Complaint
Fraud (16) Residential (32) RICO (27) .-.
Intellectual property Drugs (38) Other complaint (not speci?ed above) (42)
gm?fgl'gg?egg?g) Judicial Review Miscellaneous Civil Petition
Asset forfeiture (05) Partnership and corporate governance (21)
Employment Petition re: arbitration award (11) Other petition (not specified above) (43)
Wrongful termination (36) Writ of mandate (02)
Other employment (15) Other judicial review (39)

 

 

 

2. This case is is not complex under rule 3.400 of the California Rules of Court. If the case is complex. mark the
factors requiring exceptional judicial management: 

 

 

 

 

a. Large number of separately represented parties d. Large number of witnesses
to. Extensive motion practice raising dif?cult or novel e. Coordination with related actions pending in one or more courts
issues that will be time-consuming to resolve in other counties, states. or countries, or in a federal court
Substantial amount of documentary evidence f. Substantial postjudgment judicial supervision
3. Remedies sought (check all that apply): a. monetary b. nonmonetary; declaratory or fnjunctive relief c. punitive
4. Number oi causes of action ?esta!)- 4.- Sexual Battery in Violation of Cal .Civ.Code 1708, Sexual Assualt
5. This case is is not a class action suit.
6. If there are any known related cases. file and serve a notice oi related case. (You may use form CM-015.)
Date: April 26 2018
Lynne Brennan I,
(TYPE 08 NAME) (SE UHE OF PARTY RNEY FOR PARTY)
Ml .


n.
..,

a Plaintiff must ?le this cover sheet with the first paper filed in the action or proceeding (except small claims cases or cases ?led
,3 under the Probate Code. Family Code. or Welfare and institutions Code). (Cal. Flutes of Court. rule 3.220.) Failure to file may result
(1-. in sanctions.
on 0 File this cover sheet in addition to any cover sheet required by local court rule.
0 if this case is complex under nile 3.400 et seq. of the California Rules of Court. you must serve a copy of this cover sheet on all
other parties to the action or proceeding.
0 Unless this is a collections case under rule 3.740 or a complex case. this cover sheet will be used for statistical purposes only.

 

 

 

 

Page i of I
testimonies Us (333-; Essential CASE COVER SHEET 
Chi-010 Rev. July 1. we?) I wwcoamrtoca.

Jane D08

it?

7
a! 


stair

f"

I I 
a?

INSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET

CM-OIO

To Plaintifts and Others Filing First Papers. If you are filing a (for example, a complaint) in a civil case. ou must

complete and file. along with your first pa 
statistics about the large: and numbers 0 cases filed. You must

one box for the case

sheet must be filed only with your init

r. the Civil Case Cover

9 that best describes the case. If the ca
check the more spool to one. if the case has multiple causes of
To assist you in completing the sheet

heetcontained on
complete items 1 throug
as ?le both a general and
action. check the box that
. examples of the cases that belong under each ca
ial paper. Failure to file a cover sheet with the ?rst
its counsel. or both to sanctions under rules 2.30 and 3.220 of the Celifomia Rules of Go

To Parties in Rule 3.740 Collections Cases.

age t. This inlonnation will
6 on the sheet. In item 1. you must check

a more specific type of case listed in Item 1.
best Indicates the primary cause of action.
ype in item 1 are provided below. A cover
paper filed in a civil case may subject a party,

used to compile

A "collections case" under rule 3.740 is defined as an action for recovery of money

owed in a sum stated to be certain that is not more than $25,000. exclusive of interest and attomey?s fees, arising from a transaction in

which property. services. or mone was acquired on credit.
damages. (argunitlve damages. recovery of real
t. identification of a case as a rule 

attachmen

time-for-service requirements and case ma
case will be subject to the requrrements for

To Parties in Complex Cases.l

com 
case is complex It a plaintiff beiievest
completing the apprOpnate boxes in its
complaint on all parties to the action. A

case is complex.

Auto Tort

Auto (22)-Personai 
Damage/Wrongful Death

Uninsured Motorist (46) (if the
case involves an uninsured
motorist claim suty'ect to
arbitration, check this item
instead of Auto)

Other (Personal Inluryl
Property DemegelWrongful Death)
Tort
Asbestos (04)
Asbestos Property Damage
Asbestos Personal Iniury/
Wrongful Death
Product Liability (not asbestos or
loxr?den vironmental) (24)
Medical Malpractice (45)
Medical Malpractice-
Physicians Surgeons
Other Protesslonal Health Care
Malprac?ce
Other (23)
Premises Liability slip
and fall)
Intentional Bodily 
(8.9.. assault. vandalism)
Intentional lnf?otion of
Emotional Distress
Negligent Initiation of
Emotional Distress
Other 

(Other) Tort
Business TorttUnfalr Business
Practice (07)
Civil Rights (9.9.. discrimination.
false arrest) (not aim?

CASE TYPES AND EXAMPLES

Contract
Breach of Contract/Wananty (06)
Breach of RentallLease
Contract (not unlawful detainer
or wrongful eviction)
Contracthananty Breach-Seller
Plaintitf (not fraud or negligence)
Negligent Breach of Contract!
Warranty
Other Breach of Contract/Warranty
Collections money owed. open
bank accounts) (09)
Collection Case-Seller Plaintiff
Other Promissory Note/Collections
Case .
Insurance Coverage (not provisionally
complex) (18)
Auto Subrogation
Other Coverage
Other Contract (37)
Contractual raud
Other Contract Dispute

Real Property

Eminent 
Condemnation (14)

Wrongful Eviction (33)

Other Real Property quiet ?lls) (26)
Writ of Possession at Real Property
Mortgage Foreclosure
Chief Title
Other Real Property (not eminent
domain. landlord/tenant. or
foreclosure)

Unlawful Detainer

Commercial (31)

Residential (32)

Drugs (33) (if the case involves illegal

 



A collections case does not include an action seeking the following: (1) fort
property. (4) recovery of personal property.
.40 collections case on this form means that
nagement rules. unless a defendant files a res onsiv
service and obtaining a judgment in rule 3.7 .

ex cases only. parties must also use the Civil

case is complex under rule 3.400 of the Calif
ms 1 and 2. It a laintiff designates a case as 
. defendant may lie and serve no later than the
maintitf's designation. a counter-designation that the case is not complex. or, it the plai

or (5) a prejudgment writ of
it will be exempt from the general
a pleading. A rule 3.740 co

lections

ase Cover Sheet to designate whether the
omia Rules ol Court. this must be indicated by
omplex. the cover sheet must be served with he
time of its ?rst appearance a )olnder In the

ntill has made no designation. a designation that

Provisionally Complex Civil thigetlon (Cal.
Rules of Court Rules 3.4003403)

Regulation (03)
Construction Defect (l0)
Claims involving Mass Tort (40)
Securities Utigation (28)
Environmental?'ordc Tort (30)
insurance Coverage Claims
(arising from provisionally complex
case type listed above) (4t)

Enforcement of Judgment

Enforcement of Judgment (20)
Abstract of Judgment (Out of
Court

ll!)
Confession cl Judgment (non-
domestl'c relations)
Sister State Judgment
Administrative Agency Award
(not unpaid taxes)
PetitionlCerti?cation of Entry of
Judgment on Unpaid Taxes
Other Enforcement of Judgment

Miscellaneous Civil Complaint

RICO (27)
Other Complaint (not speci?ed
above) (42)
Declaratory Relief Only
Relief On y(norl-
harassment)
Mechanics Lien
Other Commercial Complaint
Case (non-tort/non-complex)
Other Civil Complaint
(non-tort/rlon-comptex)

Miscellaneous Civil Petition

Partnership and Corporate
Governance (21) 
Other Petition (not specified
above) (43)
Civil Harassment
Workplace Violence
ElderlDependent Adult
Abuse
Election Contest
Petition for Name 
Petition for Relief from Late
Claim
Other Civil Petition

 

dmgs. check this item; othenvise.
harassment) (03) report as Commercial or Residential)
Defamation slander. libel) Judicial Review
Hang 6) Asset Forfeiture (05)
intellectual Property (19) Award (11)
Pm't??g??amg?igm (25) Writ-Administrative Mandamus
99 in . . Writ?Mandamus on Limited Court
Otper Professronal Malpractice Case Matter
not medical or legal) - 
Other Tort (as) mama; le cw" case
Employment Other Judicial Review (39)
Wrongful Termination (36) Review of Health Of?cer Order
Other Employment (15) Notice of Appeal-Labor
Commissioner Appeals
Mr" 2?07! Essential CIVIL CASE coves 

Pogozolz

Jane Doe



- 'Orioinal



 

 

 

 

 

 

sneer True; CASE Moment;
Jane Doe v. John Doe 
COVER SHEET ADDENDUM AND BY FAX
STATEMENT OF LOCATION -

(CERTIFICATE OF GROUNDS FOR ASSIGNMENT TO COURTHOUSE LOCATION)

This form is required pursuant to Local Rule 2.3 in all new civil case ?lings In the Los Angeles Superior Court.

 

 

 

 

Step 1: After completing the Civil Case Cover Sheet (Judicial Council form find the exact case type in
Column A that corresponds to the case type indicated in the Civil Case Cover Sheet.

Step 2: in Column B. check the box for the type of? action that best describes the nature of the case.

Step 3: in Column C. circie the number which explains the reason for the court location you have

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

chosen.
Applicable Beacons for Choosing Court Filing Location (Column 
1. Class actions must be ?led in the Stanley Moslt Courthouse. Central District. 7. Location where petitioner resides.
2. Permissive tiling In central district. 3. Location wherein defendant/respondent functions wholly.
3. Location where cause of action arose. 9. Location where one or more of the parties resides.
It. Mandatory personal injury ?ling in North District. to. Location of Labor Commissioner Of?ce.
5. Location where performance required or delendanl resides. 11. Mandatory ?ling location (Huh Cases - unlawful delainer. limited
6. Location oi property or permanently garaged vehicle. - non-collection. limited collection. or personal lniury).
A i . 8 Applicable
Civil Case Cover Sheet Type of Action Reasons - See Step 3
Category No. {Check only one) Above
Auto (22) A7100 Motor Vehicle - Personal injury/Property Damege/Wronglul Death Uninsured Motorist (46) A7110 Personal Injury/Property Damage/Wrongfui Death - Uninsured Motorist 1.4. 11
>1 A6070 Asbestos Pro erty Darna 5.: 5m? A7221 Asbestos - Personal lniuryMrongiul Death 1. 11
a i
8 Product (24) A7260 Product Uebility (not asbestos or loxiclenvironmental?amalgam me A7210 Medical Malpractice- Physicians Surgeons 1.4.11
2 A7240 Other Prorasslohat Health Care Malpractice A7250 Premises Liability slip and tall) 1. 4. 11
a Pm 03:39 El A7230 intentional Bodily Injury/Property Damage/Wronglul Death (9.9.. 1. 4. 11
a wg?w Beat: assault. vandalism. etc.) :2
(923) A7270 Intentional lniliction oi Emotional Distress 1. 4, 11
a A7220 Other Personal Injury/Property DamageIWanglul Death 1. 4. 11
gay 10913023131 CIVIL CASE SHEET ADDENDUM Local ?$243
AND STATEMENT OF LOCATION 




 

5110.61 1111.63

 

CASE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Applicable
Civil Case Cover Sheet Type 01 Action Reasons . See Stop 3
Category No. (Check only one) Above
3" t!
?5 .3 Business Tort (07) A6020 Other Commercialrauslness Tort {not traudfbreach or contract} 1. 2. 3
a. 
g? Civil 8191115 (03) A6005 Civil Rights/Discrimination 1. 2. 3
g: Datamation {13) A6010 Datamation (slanderllibel) 1. 2.3
2? Fraud (16) A6013 Fraud (no contract) 1. 2.3
'6 

g: A6017 Legal Malpractice 1.2. 3
11? 32:) A6050 Other Professional Malpractice (n61 medical orlegal) 1,2,3

:0
2 OthertSS) CI A6025 omarNon-Personal Damage tort 1. 2. 3
A6037 WrongtulTermlnatlon 1. 2.3
D.
Other Employment A6024 Other Employment Complaint Case 1. 2. 3
05.1 (15) A6109 Labor Commissioner Appeals 10
Breach or Carma, A6004 Breach or RentallLease Contract (not unlawful detainer or 2. 5
Wrongful eviction)
(06) ty A6006 Contract/Warranty Breach-Seller Platntilt (no fraudmegligenca) 2.5
(not insurance) a A6019 Negligent Breach of Contract/Warranty (no fraud) 1.2.5
A6028 01113318813101 Contractharranty(not fraud ornegltgence) 1. 2. 5
Collections A6002 Collectlons Case-SellerPtaintitf 5.6.11
(09) A6012 Other Promissory Note!CollectionsCasa 5.11
a A6034 Collections Case-Purchased Debt (Charged 011 Consumer Debt 5. 6. 11
Pumhased on or alter January 1. 2014)
mum?ijgwe'age A6015 Insurance Coverage {notoornplex) 1. 2. 5.8
A6009 Contractual Fraud 1,2. 3. 5
0106257000?: A6031 70111006 Interference 1. 2.3.5
A6027 Other Contract Dlspute {not 1. 2. 3. a. 9
Eminent . . -
in?nverse a A7300 Emmant DomaEnICondemnatlon Number of parcels 2. 6
2-1 
2 "91:31?: Cl A6023 Wrongful EvictionCase 2.6
o.
a 
A6016 Mortgage Foreclosure 2.5
I:
011101 ?airmen" E3 A6032 0016111119 2. 6
A6060 Other Real Property (not eminent domain. Iandlordlt?enant. foreclosure) 2. 6
Unlawful Detainer- a . .
A6021 Unlawful Detalnor-Commorcial (not drugs orwrongful emctlon) 6. 11
.3 Commercial (31)
la -
gaxn??g' A6020 Unlawlul Bummer-Residential (not drugs or eviction) 6.11
'5 Unlawtul Detalnar-
A -P - 2, .11
Post-Foreclosure (34) El 6020 Unlawful oaner ost Foreclosure 6
Unlawtul Datalner-
I - . .11
Drugs (38} A6022 na Detalner Drugs 2 6
$113963 CIVIL CASE COVER ADDENDUM Lint-$12243
0
AND STATEMENT OF LOCATION
266601121
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CASE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Applicabie
Civil Case Cover Sheet Type of Action Reasons . See Step 3
Category No. (Check onty one) Above
Asset Forfeiture (05) a A6108 Asset Forfeiture Case 2, a. 6
a
2 
mt :fimm A6115 Petition to CompetiCcniitmNacate Arbitration 2. 5
..
lg Writ of Mandate A6151 Writ - Administrative Mandamus 2. 8
?g (02) A6152 Writ . Mandamus on Limited Court Case Matter 2
A6153 Writ - Otrter Limited Court Case Hevtew 2
Other Judiciai Review A6150 Other Writ/Judicial Review 2. 8
(39)
Antitrust/Trade .
5 Regu'a?m (03) CI A6003 Antitrusthrade Regulation 1.2. 8
?t Emma?: we? A5007 Construction Detect 1.2.3
3 . .
Claims In 1
5 76:42:19 A6006 Claims involving Mass Tort 1. 2. 6

Seou L'ti ti
93 A6035 Securities Litigation Case 1.2. 6
>0
3 Toxic Tort
.
Environmenm (30) A5036 Toxic Tort/Environmental insurance Coverage
0. 
Claims from Complex a A6014 insurance CoverageISubrogetton (comp ex case only) 1. 2, 5. 8
Case (41)
A6141 Sister State Judgment 2.5.11
5 2 Enforcement A5150 Abstract oi Judgment . 2. 6
8? o: Jud A6107 001116de of Judgment (nonoornestic relations) 2.9
.2 5; (209) A6140 Administrative Agency Award (not unpaid taxes) 2. 8
In ?5 CI A6114 PetitionICerti?cate for Entry of Judgment on Unpald Tax 2. a
A6112 Other Eniorcement oi Judgment Case 2. a. 9
'3 3 RICO
a (27) A6033 Racketeering (RICO) Case 1. 2. a
5 Other Complaints A5030 Declaratory Heiief Oniy 1.2.6
3 8 (Not Speci?ed Above) A6040 lnjunctive Relief Ordy (not domestic/harassment) 2.6
3 (42) A6011 Other Commerciet Complaint Case (non-toninon-comptex) 1.2.8
0 Cl A6000 Other Civil Comptatnt inon-tortinon-complax) 1. 2, 6
Partnership Corporation .
.
Gave (21) A6113 and Corporate Govemance Case 2 8
ES 
2 A5121 Civit Harassment 2.3.9
1: 01 11'
a "Brine Cl A6123 Workplace Harassment 2.3.9
-- a. (Not Streamed Above)
3 {43) A6124 ElderlDependent Adult Abuse Case 2, 3, 9
?3 CI
-- A6190 Election Contest 2
a 
A6110 Petition tor Change 01 NameIChange of Gender 2. 7
A6170 Petition tor Reliet irom Late Claim Law 2. 3. 6
A6100 Other Civii Petition 2. 9

 

 

LA-giv 100 (Rev 2116)
LAtsCAdproved 0304

'iEseen?al-


CIVIL CASE cost? SHEET ADDENDUM

AND STATEMENT OF LOCATION

 

 

 

SHORT 

 

 

Jane Doe v. John Doe

CASE NUMBER

 

 

Step 4: Statement of Reason and Address: Check the appropriate boxes tor the numbers shown under Column for the

type of action that you have selected. Enter the address which is the basis

(No address required for class action cases).

tor the tiling location. including zip code.

 

REASON:




Los Angeles, CA

 

 

 

 

 

 

cm: some; zit} cone:
Los Angeles 90012
Step 5: Certi?cation of Assignment: I certily that this case is property filed in the Central District of

the Superior Court of California. County of Los Angeles [Code Civ. Proc.. ?392 et seq.. and Local Rule 

Dated: April 26,

2018

%57

 

(SIGNATURE or PARTY)

PLEASE HAVE THE FOLLOWING COMPLETED AND READY TO BE FILED IN ORDER TO PROPERLY
COMMENCE YOUR NEW COURT CASE:

1- Original Complaint or Petition.

2. If tiling a Complaint. 3 completed Summons form for issuance by the Clerk

3. Civil Case Cover Sheet. Judicial Council form 

4. Civil Case Cover Sheet Addendum and Statement of Location ton-n. LACIV 109. LASC Approved 03-04 (Rev.

02/16).

5. Payment in lull ol the ?ling fee. unless there is court order for waiver. partial or scheduled payments.

6. A signed order appointing the Guardian ad Litem. Judicial Council form CHI-010. if the plaintiff or petitioner is a
minor under 18 years of age will be required by Court in order to issue a summons.

7. Additional copies of documents to be conformed by the Clerk. Copies of the cover sheet and this addendum
must be served along with the summons and complaint. or other initiating pleading in the case.

 

sesame. CIVIL CASE coTEn SHEET ADDENDUM 931.53% 23
AND STATEMENT OF LOCATION -
CEBS Essential

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