Case Information And Litigant Data Sheet Page 4

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Defendant(s)  ‐‐ Page 2  
CASE INFORMATION AND LITIGANT DATA FORM    
 
EMAIL ADDRESS: 
___________________________________________        ______________________________________  
 
 
HOME TELEPHONE: (____)________________________  
 (_____)__________________________________  
CELL NUMBER:  (_____)__________________________            (_____)__________________________________  
WORK NO.: __(______)__________________________             (______)________________________________  
FAX NO.: _(_______)____________________________             (_____)_________________________________   
 
 
 
Check here if there are more than two (2) defendants and/or defense attorneys involved in this case, and attach  a separate sheet 
that includes the required  information for all such additional persons. 
 
 
 
SIGNATURE(S)  ‐‐  (Each Defense Attorney or Pro Se Defendant is Required to Sign and Date the document below): 
 
 
___________________________________________________              ______________________________________________  
PRINT 
 
 
 
 
 
 
  PRINT 
 
___________________________________________________              _______________________________________________     
SIGNATURE 
 
 
 
 
 
   SIGNATURE 
 
_____________________________ 
 
 
 
 ________________________________  
DATED 
 
 
 
 
 
 
 DATED 
 
 
 
 
 
 
 
 
 
Rev. 05/2013 
 
 
 
 
 
 
 
       Super. Ct. Form 1‐0001, Part V

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