FL-165: FL 165 Form | CA Small Claims

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Atty Bar No

Name

Atty Firm

Street

City

State

Zip

Phone

Fax

Email

Atty For

Crt County

Crt Street

Crt Mailing Add

Crt City Zip

Crt Branch

Party

Case Number

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Sig Date

Sig Name

Sig Date

Sig Name

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Sig Date

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Reason

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Party

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