Breach Of Contract Small Claims Page 3

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G Except defendant (nam e):
who is:
G a Tribal governm ent
G a business organization, form unknown
G a corporation
G an unincorporated entity (describe):
G a public entity (describe):
G other (specify):
b. The true nam es and capacities of defendants sued as Does are unknown to plaintiff.
c. G Inform ation about additional defendants who are not natural persons is contained in
Com plaint--Attachm ent 3c.
4. G Plaintiff is required to com ply with a claim s statute, and
a. G plaintiff has com plied with applicable claim s statutes, or
b. G plaintiff is excused from com plying because (specify):
5. This action is filed in tribal court because:
a. G defendant(s) entered into the contract on the Blue Lake Rancheria.
b. G defendant(s) is an enrolled m em ber of the Blue Lake Rancheria.
c. G defendant(s)
live(s) on the Blue Lake Rancheria.
d. G the contract was to be perform ed on the Blue Lake Rancheria.
e. G defendant(s)
is a corporation or unincorporated
association and its principal place of business is located on the Blue Lake Rancheria.
f. G the real property that is the subject of this action is owned by the United States of
Am erican in trust for the Blue Lake Rancheria.
g. other (specify):
6. G The following paragraphs of this pleading are alleged on inform ation and belief (specify
paragraph num bers):
7. The following causes of action are attached and the statem ents above apply to each: (Each
com plaint m ust have one or m ore causes of action attached.)
Mandatory Small Claims Form BC-110
3

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