Sample California request for statement of damages

This request for statement of damages for California is pursuant to Section 425.11 of the Code of Civil Procedure, and is to be used by a defendant in a personal injury or wrongful death case in California. The author is a freelance paralegal who has worked in California and Federal litigation since 1995 and has used this sample for many years.

Note that the author is NOT an attorney and no guarantee or warranty is provided.

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Any Attorney or Party
Any Street
Any Town, CA 99999
555-555-5555
Any Attorney or Party
Superior Court of the State of California
For the County of ____________
Any Plaintiff,
Plaintiff,
vs.
Any Defendant,
Defendants.
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Case No.
REQUEST FOR STATEMENT OF DAMAGES
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TO PLAINTIFF, ____________________ AND THEIR ATTORNEYS OF RECORD:
NOTICE IS HEREBY GIVEN that Defendant, _________________________________
pursuant to Code of Civil Procedure Section 425.11, hereby requests that you provide a Statement of
Damages setting forth the nature and amount of the damages being sought against Defendant,
__________________in the above-entitled action.
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REQUEST FOR STATEMENT OF DAMAGES

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Said Statement of Damages must be in writing and served on the requesting party within 15
days of the date of service of this Request for Statement of Damages.
Dated________________ _______________________________________________
ANY ATTORNEY OR PARTY
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REQUEST FOR STATEMENT OF DAMAGES

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PROOF OF SERVICE
I am over the age of 18 and not a party to this action.
I am a resident of or employed in the county where the mailing occurred; my
business/residence address is: ADDRESS OF PERSON SERVING PAPERS.
On ____________________ I served the foregoing document(s) described as: REQUEST
FOR STATEMENT OF DAMAGES to the following parties:
NAME AND ADDRESS OF ATTORNEY FOR OTHER PARTY OR OTHER PARTY
[X] (By U.S. Mail) I deposited such envelope in the mail at ___________California,
with postage thereon fully prepaid. I am aware that on motion of the party
served, service is presumed invalid if postal cancellation date or postage meter
date is more than one day after date of deposit for mailing in affidavit.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
DATED: ______________
_______________________________________
NAME OF PERSON SERVING PAPERS
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REQUEST FOR STATEMENT OF DAMAGES

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PROOF OF SERVICE
I am over the age of 18 and not a party to this action.
I am a resident of or employed in the county where the mailing occurred; my
business/residence address is: ADDRESS OF PERSON SERVING PAPERS.
On ____________________ I served the foregoing document(s) described as: REQUEST
FOR STATEMENT OF DAMAGES to the following parties:
NAME AND ADDRESS OF ATTORNEY FOR OTHER PARTY OR OTHER PARTY
[X] (By U.S. Mail) I deposited such envelope in the mail at ___________California,
with postage thereon fully prepaid. I am aware that on motion of the party
served, service is presumed invalid if postal cancellation date or postage meter
date is more than one day after date of deposit for mailing in affidavit.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
DATED: ______________
_______________________________________
NAME OF PERSON SERVING PAPERS
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REQUEST FOR STATEMENT OF DAMAGES

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PROOF OF SERVICE
I am over the age of 18 and not a party to this action.
I am a resident of or employed in the county where the mailing occurred; my
business/residence address is: ADDRESS OF PERSON SERVING PAPERS.
On ____________________ I served the foregoing document(s) described as: REQUEST
FOR STATEMENT OF DAMAGES to the following parties:
NAME AND ADDRESS OF ATTORNEY FOR OTHER PARTY OR OTHER PARTY
[X] (By U.S. Mail) I deposited such envelope in the mail at ___________California,
with postage thereon fully prepaid. I am aware that on motion of the party
served, service is presumed invalid if postal cancellation date or postage meter
date is more than one day after date of deposit for mailing in affidavit.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
DATED: ______________
_______________________________________
NAME OF PERSON SERVING PAPERS
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REQUEST FOR STATEMENT OF DAMAGES

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PROOF OF SERVICE
I am over the age of 18 and not a party to this action.
I am a resident of or employed in the county where the mailing occurred; my
business/residence address is: ADDRESS OF PERSON SERVING PAPERS.
On ____________________ I served the foregoing document(s) described as: REQUEST
FOR STATEMENT OF DAMAGES to the following parties:
NAME AND ADDRESS OF ATTORNEY FOR OTHER PARTY OR OTHER PARTY
[X] (By U.S. Mail) I deposited such envelope in the mail at ___________California,
with postage thereon fully prepaid. I am aware that on motion of the party
served, service is presumed invalid if postal cancellation date or postage meter
date is more than one day after date of deposit for mailing in affidavit.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
DATED: ______________
_______________________________________
NAME OF PERSON SERVING PAPERS
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REQUEST FOR STATEMENT OF DAMAGES