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CIV-110 <br />PLAINTIFF/PETITIONER: JENNIFER CHAN CASE NUMBER: <br />DEFENDANT/RESPONDENT: REINA CASTRO MARTINEZ, et al. 30-2020 01139971 <br />COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS <br />If a party whose court fees and costa were initially waived has recovered or will recover $10,000 or <br />more In value by way of settlement, compromise, arbitration award, mediation settlement, or other <br />means, the court has a statutory lien on that recovery. The court may refuse to dismiss the case until <br />the lien is satisfied. (Gov. Code, § 68637.) <br />Declaration Concerning Waived Court Fees <br />1. The court waived court fees and costa in this action for (name): NIA <br />2. The person named in item 1 Is (check one below): <br />a. © not recovering anything of value by this action. <br />b. recovering less than $10,000 In value by this action, <br />c. 0 recovering $10,000 or more In value by this action. (If Item 2c is chocked, Item 3 must be completed.) <br />3. 0 All court fees and court costs that were waived In this action have been paid to the court (check one): 0 Yes = No <br />I declare under penally of perjury under the laws of the State of California that the information above is true and correct. <br />Date: 1/8121 <br />Rolf). Rolnicki <br />(TYPE OR PRINT NAME OF ATTORNEY PARK MAIGNG DECLARATION) (SIGNATURE) <br />0*1101Ray. January 1.20101 REQUEST FOR DISMISSAL Pepe 2 012 <br />