NOTICE TO CONSUMER |
DO NOT SIGN ANYTHING BEFORE YOU READ THIS PAGE |
In the first conversation when you contacted [the unlawful detainer assistant or the legal document assistant], did [he or she] explain . . . . . . . . . |
[Name of unlawful detainer assistant or legal document assistant] is not an attorney. |
[Name of corporation or partnership, if any, that is offering legal document assistant services or unlawful detainer assistant services] is not a law firm. |
[He/she/name of the business] cannot represent you in
court. |
[He/she/name of the business] cannot advise you about your legal rights or the law. |
[He/she/name of the business] cannot select legal forms for you. |
[He/she/name of the business] is registered in [county name] and the registration number is [registration number]. |
[He/she/name of the business]’s registration is valid until [date of expiration of registration], after which it must be renewed. |
To confirm that [he/she/name of business] is registered, you may contact the [county name] clerk’s office at [office address], [or] [office phone number], [or] [if available, office Internet Web site]. |
Choose one: |
Yes, [he/she] explained. |
No, [he/she] did not explain. |
Date: |
Signature: |
[NAME OF INSTITUTION / LOGO]
_____
_____
Date: [insert date] | ||
NOTICE OF DATA BREACH | ||
What Happened | ||
What Information Was
Involved | ||
What We Are Doing | ||
What You Can Do | ||
Other Important Information [insert other important information] | ||
For More Information | Call [telephone number] or go to [Internet Web site] |
[NAME OF INSTITUTION / LOGO]
_____
_____
Date: [insert date] | ||
NOTICE OF DATA BREACH | ||
What Happened | ||
What Information Was Involved | ||
What We Are Doing | ||
What You Can Do | ||
Other Important Information [insert other important information] | ||
For More Information | Call [telephone number] or go to [Internet Web site] |
(Signature of Voter) |
SECTION OF NOMINATION PAPER SIGNED BY VOTER ON BEHALF OF PRESIDENTIAL PREFERENCE PRIMARY CANDIDATE | ||
Section ____________Page ____________ | ||
County of __________. Nomination paper of a presidential preference candidate for the Green Party presidential preference primary ballot. | ||
State of California County of | ⎱ ⎰ | ss. |
SIGNER’S STATEMENT | ||
I, the undersigned, am a voter of the County of ____________, State of California, and am registered as preferring the Green Party. I hereby nominate ____________ for the presidential preference portion of the Green Party’s presidential primary ballot, to be voted for at the presidential preference primary to be held on the____________ day of ____________, 20____. I have
not signed the nomination paper of any other candidate for the same office. | ||
Number_________Signature_________Printed name_________Residence | ||
1. | ||
2. | ||
3. | ||
etc. | ||
CIRCULATOR’S DECLARATION | ||
I, ________, affirm all of the following: 1.That I am 18 years of age or older. 2.That my residence address, including street number, is . [If no street or number exists, a designation of my residence adequate to readily ascertain its location is .] 3.That I secured signatures in the County of ________ to the nomination paper of a candidate in the presidential preference primary
of the Green Party, that all the signatures on this section of the nomination paper numbered from 1 to ______, inclusive, were made in my presence, that the signatures were obtained between ____________, 20__, and ____________, 20__, and that to the best of my knowledge and belief each signature is the genuine signature of the person whose name it purports to be. I declare under penalty of perjury that the foregoing is true and correct. Executed at ________, California, this ____ day of ____, 20__. [Signed] ______________________________ Circulator [Printed Name] _____________________________ |
California Statutory Forms for Assisted Reproduction, Form 1: |
Two Married or Unmarried People Using Assisted Reproduction to Conceive a
Child |
Use this form if: You and another intended parent, who may be your spouse or registered domestic partner, are conceiving a child through assisted reproduction using sperm and/or egg donation; and one of you will be giving birth. |
WARNING: Signing this form does not terminate the parentage claim of a sperm donor. A sperm donor’s claim to parentage is terminated if the sperm is provided to a licensed physician and surgeon or to a licensed sperm bank prior to insemination, or if you conceive without having sexual intercourse and you have a written agreement signed by you and the donor that you will conceive using assisted reproduction and do not intend for the donor to be a parent, as required by Section 7613(b) of the Family Code. |
The laws about parentage of a child are complicated. You are strongly encouraged to consult with an attorney about your rights. Even if you do not fill out this form, a spouse or domestic partner of the parent giving birth is presumed to be a legal parent of any child born during the marriage or domestic partnership. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using sperm and/or egg donation. |
I, ____________________ (print name of person not giving birth), intend to be a parent of
a child that ____________________ (print name of person giving birth) will or has conceived through assisted reproduction using sperm and/or egg donation. I consent to the use of assisted reproduction by the person who will give birth. I INTEND to be a parent of the child conceived. |
SIGNATURES |
Intended parent who will give birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent who will not give birth: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
California Statutory Forms for Assisted Reproduction, Form 2: |
Unmarried, Intended Parents Using Intended Parent’s Sperm to Conceive a Child |
Use this form if: (1) Neither you or the other person are married or in a registered domestic partnership (including a registered domestic partnership or civil union from another state); (2) one of you will give birth to a child conceived through assisted reproduction using the intended
parent’s sperm; and (3) you both intend to be parents of that child. |
Do not use this form if you are conceiving using a surrogate. |
WARNING: If you do not sign this form, or a similar agreement, you may be treated as a sperm donor if you conceive without having sexual intercourse according to Section 7613(b) of the Family Code. |
The laws about parentage of a child are complicated. You are strongly encouraged to consult with an attorney about your rights. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using sperm donation. |
I, ____________________ (print name of parent giving birth), plan to use assisted reproduction with another intended parent who is providing sperm to conceive the child. I am not married and am not in a registered domestic partnership (including a registered domestic partnership or civil union from another jurisdiction), and I INTEND for the person providing sperm to be a parent of the child to be conceived. |
I, ____________________ (print name of parent providing sperm), plan to use assisted reproduction to conceive a child
using my sperm with the parent giving birth. I am not married and am not in a registered domestic partnership (including a registered domestic partnership or civil union from another jurisdiction), and I INTEND to be a parent of the child to be conceived. |
SIGNATURES |
Intended parent giving birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent providing sperm: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the officer) |
personally
appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
California Statutory Forms for Assisted Reproduction, Form 3: |
Intended Parents Conceiving a Child Using Eggs from One Parent and the Other Parent Will Give Birth |
Use this form if: You are conceiving a child using the eggs from one of you and the other person will give birth to the child; (2) and you both intend to be parents to that child. |
Do not use this form if you are conceiving using a surrogate. |
WARNING: Signing this form does not terminate the parentage claim of a sperm donor. A sperm donor’s claim to parentage is terminated if the sperm is provided to a licensed physician and surgeon or to a licensed sperm bank prior to insemination, or if you conceive without having sexual intercourse and you have a written agreement signed by you and the donor that you will conceive using assisted reproduction and do not intend for the donor to be a parent, as required by Section 7613(b) of the Family Code. |
The laws about parentage of a child are complicated.
You are strongly encouraged to consult with an attorney about your rights. |
This form demonstrates your intent to be parents of the child you plan to conceive through assisted reproduction using eggs from one parent and the other parent will give birth to the child. |
I, ____________________ (print name of parent giving birth), plan to use assisted reproduction to conceive and give birth to a child with another person who will provide eggs to conceive the child. I INTEND for the person providing eggs to be a parent of the child
to be conceived. |
I, ____________________ (print name of parent providing eggs), plan to use assisted reproduction to conceive a child with another person who will give birth to the child conceived using my eggs. I INTEND to be a parent of the child to be conceived. |
SIGNATURES |
Intended parent giving birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
Intended parent providing eggs: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of )
_____
|
On before me, (insert name and title of the officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
California Statutory Forms for Assisted Reproduction, Form 4: |
Intended Parent(s) Using a Known Sperm and/or Egg Donor(s) to Conceive a Child |
Use this form if: You are using a known sperm and/or egg donor(s), or embryo donation, to conceive a child and you do not intend for the donor(s) to be a parent. |
Do not use this form if you are conceiving using a surrogate. |
If you do not sign this form or a similar agreement, your sperm donor may be treated as a parent unless the sperm is provided to a licensed physician and surgeon or to a licensed sperm bank prior to insemination, or a court finds by clear and convincing evidence that you planned to conceive through assisted reproduction and did not intend for the donor to be a parent, as required by Section 7613(b) of the Family Code. If you do not sign this form or a similar agreement, your egg donor may be treated as a parent unless a court finds that there is satisfactory evidence that you planned to conceive through assisted reproduction and did not intend for the donor to be a parent, as required by Section 7613(c) of the Family
Code. |
The laws about parentage of a child are complicated. You are strongly encouraged to consult with an attorney about your rights. |
This form demonstrates your intent that your sperm and/or egg or embryo donor(s) will not be a parent or parents of the child you plan to conceive through assisted reproduction. |
I, ____________________ (print name of parent giving birth), plan to use assisted reproduction to conceive using a sperm and/or egg donor(s) or embryo donation, and
I DO NOT INTEND for the sperm and/or egg or embryo donor(s) to be a parent of the child to be conceived. |
(If applicable) I, ____________________ (print name of sperm donor), plan to donate my sperm to____________________ (print name of parent giving birth and second parent if applicable). I am not married to and am not in a registered domestic partnership (including a registered domestic partnership or a civil union from another jurisdiction) with ____________________ (print name of parent giving birth), and I DO NOT INTEND to be a parent of the child to be conceived. |
(If applicable) I, ____________________ (print name of egg donor),
plan to donate my ova to____________________ (print name of parent giving birth and second parent if applicable). I am not married to and am not in a registered domestic partnership (including a registered domestic partnership or a civil union from another jurisdiction) with ____________________ (print name of parent giving birth), or any intimate and nonmarital relationship with ____________________ (print name of parent giving birth) and I DO NOT INTEND to be a parent of the child to be conceived. |
(If applicable) I, ____________________ (print name of intended parent not giving birth), INTEND to be a parent of the child that____________________ (print name of parent giving birth) will conceive through assisted reproduction using sperm and/or egg donation and
I DO NOT INTEND for the sperm and/or egg or embryo donor(s) to be a parent. I consent to the use of assisted reproduction by the person who will give birth. |
SIGNATURES |
Intended parent giving birth: ___________________ (print name) |
________________________ (signature) ____________(date) |
(If applicable) Sperm Donor: ___________________ (print name) |
________________________ (signature) ____________(date) |
(If
applicable) Egg Donor: ___________________ (print name) |
________________________ (signature) ____________(date) |
(If applicable) Intended parent not giving birth: ____________ (print name) |
_________________________ (signature) ___________(date) |
NOTARY ACKNOWLEDGMENT |
State of California |
County of
)
_____
|
On before me, (insert name and title of the officer) |
personally appeared , |
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity, and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. |
I certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true and correct. |
WITNESS my hand and official seal. |
Signature(Seal) |
Type of Facility | Fee | |
General Acute Care Hospitals | $134.10 | per bed |
Acute Psychiatric Hospitals | $134.10 | per bed |
Special Hospitals | $134.10 | per bed |
Chemical Dependency Recovery Hospitals | $123.52 | per bed |
Skilled Nursing Facilities | $202.96 | per bed |
Intermediate Care Facilities | $202.96 | per bed |
Intermediate Care Facilities- Developmentally Disabled | $592.29 | per bed |
Intermediate Care Facilities-
Developmentally Disabled-Habilitative | $1,000.00 | per facility |
Intermediate Care Facilities- Developmentally Disabled-Nursing | $1,000.00 | per facility |
Home Health Agencies | $2,700.00 | per facility |
Referral Agencies | $5,537.71 | per facility |
Adult Day Health Centers | $4,650.02 | per facility |
Congregate Living Health Facilities | $202.96 | per bed |
Psychology Clinics | $600.00 | per facility |
Primary Clinics- Community and Free | $600.00 | per facility |
Specialty Clinics- Rehab Clinics (For
profit) | $2,974.43 | per facility |
(Nonprofit) | $500.00 | per facility |
Specialty Clinics- Surgical and Chronic | $1,500.00 | per facility |
Dialysis Clinics | $1,500.00 | per facility |
Pediatric Day Health/Respite Care | $142.43 | per bed |
Alternative Birthing Centers | $2,437.86 | per facility |
Hospice | $1,000.00 | per provider |
Correctional Treatment Centers | $590.39 | per bed |
(Signature of Solicitor, Solicitor Firm, or Other Representative) [Typed Name and Address of Plan, Solicitor, or Solicitor Firm] | |
(Applicant’s Signature) | |
(Date) |
(Signature of Agent, Broker, or Other Representative) | |
(Signature of Applicant) | |
(Date) |
Aggregate number of documents recorded and documents filed in the preceding calendar year in all counties where the company is licensed to transact business | |||
---|---|---|---|
Number of documents | Amount of required minimum net worth | Amount of bond or cash deposit | |
Less than 50,000
........................
| $ 75,000 | $ 50,000 | |
50,000 to 100,000
........................
| 120,000 | 50,000 | |
100,000 to 500,000
........................
| 200,000 | 100,000 | |
500,000 to 1,000,000
........................
| 300,000 | 100,000 | |
1,000,000 or more
........................
| 400,000 | 100,000 |
If the adjusted gross income is: | The percentage of credit is: |
---|---|
$40,000 or less
........................
| 63% |
Over $40,000 but not over $70,000
........................
| 53% |
Over $70,000 but not over $100,000
........................
| 42% |
Over $100,000
........................
| 0% |
If the adjusted gross income is: | The percentage of credit is: |
---|---|
$40,000 or less
........................
| 50% |
Over $40,000 but not over $70,000
........................
| 43% |
Over $70,000 but not over $100,000
........................
| 34% |
Over $100,000
........................
| 0% |
Jurisdiction | Allocation Percentage |
Alameda
........................
| 4.5046 |
Alpine
........................
| 0.0137 |
Amador
........................
| 0.1512 |
Butte
........................
| 0.8131 |
Calaveras
........................
| 0.1367 |
Colusa
........................
| 0.1195 |
Contra Costa
........................
| 2.2386 |
Del Norte
........................
| 0.1340 |
El Dorado
........................
| 0.5228 |
Fresno
........................
| 2.3531 |
Glenn
........................
| 0.1391 |
Humboldt
........................
| 0.8929 |
Imperial
........................
| 0.8237 |
Inyo
........................
| 0.1869 |
Kern
........................
| 1.6362 |
Kings
........................
| 0.4084 |
Lake
........................
| 0.1752 |
Lassen
........................
| 0.1525 |
Los Angeles
........................
| 37.2606 |
Madera
........................
| 0.3656 |
Marin
........................
| 1.0785 |
Mariposa
........................
| 0.0815 |
Mendocino
........................
| 0.2586 |
Merced
........................
| 0.4094 |
Modoc
........................
| 0.0923 |
Mono
........................
| 0.1342 |
Monterey
........................
| 0.8975 |
Napa
........................
| 0.4466 |
Nevada
........................
| 0.2734 |
Orange
........................
| 5.4304 |
Placer
........................
| 0.2806 |
Plumas
........................
| 0.1145 |
Riverside
........................
| 2.7867 |
Sacramento
........................
| 2.7497 |
San Benito
........................
| 0.1701 |
San Bernardino
........................
| 2.4709 |
San Diego
........................
| 4.7771 |
San Francisco
........................
| 7.1450 |
San Joaquin
........................
| 1.0810 |
San Luis Obispo
........................
| 0.4811 |
San Mateo
........................
| 1.5937 |
Santa Barbara
........................
| 0.9418 |
Santa Clara
........................
| 3.6238 |
Santa Cruz
........................
| 0.6714 |
Shasta
........................
| 0.6732 |
Sierra
........................
| 0.0340 |
Siskiyou
........................
| 0.2246 |
Solano
........................
| 0.9377 |
Sonoma
........................
| 1.6687 |
Stanislaus
........................
| 1.0509 |
Sutter
........................
| 0.4460 |
Tehama
........................
| 0.2986 |
Trinity
........................
| 0.1388 |
Tulare
........................
| 0.7485 |
Tuolumne
........................
| 0.2357 |
Ventura
........................
| 1.3658 |
Yolo
........................
| 0.3522 |
Yuba
........................
| 0.3076 |
Berkeley
........................
| 0.0692 |
Long Beach
........................
| 0.2918 |
Pasadena
........................
| 0.1385 |