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MINUTES - 07082008 - C.31
CLAIM � .BOARD Of,- SUPERVISORS OF CONTRA COSTA COUNTY BOARDACTION: Claim Against the County, or District Govenied by ) C 3[ . V the Board of Supervisors, Routing Endorsements, ) OI'ICE TO CLAIMANT and Board Action. All Section references are to ) flte copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claire by the Board of M���� Supervisors. (Paragraph IV below), 1111 given Pursuant to Government Code MAY AMOUNT: 3 ® ZOQS Section 913 and 915.4. Please dote all COUNTY COUNSEL "Wa1'nirlgs". . CLAIMANT: WRTINEZ CALIF ATTORNEY: A rc.,.Ve L9WI DATE RECEIVED: �(� ��I 2W3 ADDRESS: _C). ptQ`I I% BY DELIVERY TO CLERK ON: Y)IC. 9 BY :MAIL POSTMARKED: FROM: Clerk of-tile Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, C erk Dated: By: Deputy 11. FROM:FROM.: County Counsel TO: Clerk of the Board of Supervisors (,This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are.so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that. it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Otller: �-l CJD�/ Dated: c� By: / Deputy County Counsel 111. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV..,BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected iii full. ( ) Other: I certify that this is a true. and correct copy of the Board's Oi•der entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By eputy Clerk WAR Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the niail to file a court action on this chaim.See Government Code Section 945.6.You may seek the advice of an attorney of•your choice in connection with this matter. If'you want to consult an attorarey,you should do so imrirediately. *For Additional Warning See Reverse Side of'T7ris Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that f. ani now, and at all times herein mentioned, have been a citizen of• the .United States,.over age 1.8; and that today i deposited in the United States Postal Service in f%lartiirez, California, postage bully prepaid a certified copy of this .Board Order and Notice to Claimant, addressed to the clainran.t as shown above. Date JOHN CULLEN, CLERK By Deputy Clerk MA;Y,123, 2008 4: 17PM CCC R SK MANAGEMENT Nd, 361 P. 2 BOARD OF SLIP SOPS OF CONTRA,COSTA COGry >T'S'1'RUCTIONS TO C� A. A claim relating to a cause of action for death or for injury to person or to personal property of growing crops shall be presented not later than six months after the acaual of the cause of action A claire relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez, CA 945 53. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filled against each. public entity. B. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this farm. as asaaads as Kin aWEass amVa§eaas■seasaa■sf■aaaRsss Rd a all sssaa males so RassRa1KmsVr■al RE: Claim By: Reserved for Clerk's fling stamp 7:B0AR!D_(:TF OVE® Against the County of Contra Costa or ) 8 2008 CLERSUPERL'lSORS District) OSTA Co. (Fill in the name) The undersigned claimant hereby mimes claim against the County of Contra Costa or the above-named district is the sum of$ and in support of this claim represents as follows: S � ma V �uS h d' �e e-4 c� L When did the damage or injury occur? (('rive exact dale awl lza�) au, N 0 pM 2. Where did the damage or injury occur-?11 (Include city/Iand county) 04 kv4 (tot 3. How did the damage or injury occur? (Give full details;use extra pap//er if required) �i �av( bv Gctru) IFul << � fE'c�.l Pn c(Pb D U-f5 4. What partiaular'act or omission on.the pare of county or district officers, servants, or employees caused the i MAY. 23. 2008 4: 17PM CCC RISK MANAGEMENT N0. 361 P. 3 ' your resulted? Crive full extJtof' injuries or damages 6. Vrzet damage or �niune s do yo claim claimed. Attach two estimates for auto damage.) r 6\ v! 'ate o\I v VJ. '7. How was the amount claimed above computed? (Include the estimated am.ovnt of any prospective injury or damage.} ,S S 8- Names and addresses of witnesses,doctors, and hospitals: g. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT paaaaaarasRaaesRusso a■rasa■raR■rsas■rasa■a■sas■ssRarsss■■s■■■ses■aassaasseaarRRir:aa .Gov. Code Sec, 910.2 provides"The claim shall be signed by the claimant or by some person on his SEND NOTICES TO: (Attorm )behalf." vl 1 Name and address of Attomey ) V (Claimant's Signature) P O �'0 d1 S S G , �p C j (Address) CA ?q(t C i�Yt kZ ou 00 On ) Telephone No. )T elephone No. :2012– 2a4 ^ I's-1-0 -e?C man USURP muzmmgwmxsan wpm I a xx am a zxW*UNVPWWX am us Ram a NX%b man WE sung Whings go we as X Risk cup%off"I PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim tiled with the County under the Tort Claims Act,is subject to public disclosure under the California Public Records Act. (Gov. Code, 55 6500 et seq.) Furthermore, any attacbments,ad.dendums, or supplements attached to the claim form,including medical records, are also subj wt to public disclostne. zra■■saassa■■aaoR■raasse■rsss■■asssrrraassseaa■■seasast■asssr■rraass■■rsar■aaaea■esaF NOTICE: Section 72 of the Penal Code provides.- Every rovides:Every person who, with intent to defraud,presmts for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the Comity jail for a period of not more than one year, by s fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and file, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000),or by both such imprisonment and fine. SPM wr'` MERCURY( z INSURANCE GROUP � � �"""� /�c� 02 1A P.O. Box 997195 Sacramento,California 95899-7195 0004396586 MAY 27 2008 MAILED FROM ZiPCODE 956 70 aU '-o CJW� A�m� • v:1�t 55-3 ... .... ..:3.:•,",•.?....... ._. ... ._ .. II}IIiRIP}�4 1�F} } }}I IFfIF111JI61i 1 x}1}11.111111J}i11111I C LA iNI BOARD OF SUPERVI.SO.RS OF CONTRA COSTA COUNTY • BOARD ACTION:J Claim Against the County, or District Governed by. ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are f� I'he copy of this document mailed to California Government Codes. D � ts� you. is your notice of the action taken on your claim.by-tile Board of 410�JUN U 4 ZOOS Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: 2d MARTINEZ CALIF. Section 913 and 915.4. Please note all t "Warnings". CLAIMANT: l�Sl�►A� �itiw�Q� i'trG1 �b f��0i1 GL i01� ATTORNEY: DATE RECEIVED: '\1 RAC, 1+ ADDRESS: V10,. OOX q 2D BY DELIVERY-TO CLERK ON: b10-12 BY MAIL POSTMARKED: Cy4e 22 2000. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL E , C'lerk Dated:JWW /4- �v� By: Deputy 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3).. O Other: Dated: (� ��l By: Deputy County Counsel 111. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section.911.3). 1V. R6ARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( .} Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: HN CULLEN, CLERK, By Deputy Clerk WARN1. G (%ov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personalty served or deposited in the snail to file a court action on this chain.See Governnient Code Section 945.6.You may seek the advice of an attorney of your choice in connection widr this matter. If'you want to consult an attorney,you should do so immediately. *For Addi6(xial Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of per jury that 1. am now, and at.all t,innes herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the.United . States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: m JOHN CULLEN, CLERK By Deputy Clerk N1,A' ^' \(1 n `:'%• n 1 NifilJ�uEfv�Ef, :O, 38�� P. 2 212U0 y : ?i;�.: , SCC E;I3I BOARD OF SUPERVISORS OF COMA, COSTA CQU`ITY INSTRUCTIONS Tl O CLADIANT A. A claim relating to a cause of action for death o: for injury to person or to personal property or growing crops shall be presented not later fhan six months after the aomual, of the cause of action. A claim relating to any other cause of action shall be.presented not Tato; than one year afker the acorud of the cause of action. (Gov.:Code § 911.2.) B. Clams must be filed with the Clerk of the Board of Supervisors at its office in Room. 106, County Administration.Building, 651 Fine Street,_%Lrtinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each Public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of flus form. MEME KKK R■iaXaaaaarlaMOVE NOR ENO Easy MR.Ra■■as Rape MON ARM 1Y an Csoff ER R1 ISE: Claim By: Reserved for Clerk's filing stamp ) "HEC UVED Against the County of Co tra Cos or ) .` c8. �Yn D' - kc �� },• SUN 0 4 200 i \ `I l (1:` V� nrl C Z District) CLERK-BOARD OF SUP:Rv soRs (Fill m th e) CONTRA COSTA CO. e vi iz L S -- nlnl)C I ,, 6 Cl The undersigned claimant hereby makes claim against the County of Contra. Costa or the above-named di.stict in the sum of$ and in supportof this claim represents as follows: 1. When did tae dama e or injury occur? (Give exact date and hour) _aoc)R 1 1-;)-0 2. Where did the damage or injury occur? (Include city and county) 0. a. How did the damage or injury occur? (Give full details;use extra paper if required) PO 1, 1 C 0�. c- Wbat-pardcular-act or.omission on the.part of county or district officers, servants,or employees caused the injury or damage? .. 3 5 What are the-aames of collnaty or district of vers, servants, or employees cawing the dam,agt or M1121y?...__.._..._ J (- k, ,��o eJ fr1A!', '3. 2�� �$ 9 : I .i��i CCC :ISK MA�`;ASEfv1E.P fd0. 380 P. 3 r , 6. Wei damage or injuries do your claim.resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) , C 1he, IA ,cleY�. Grnk7_ How was amount claimed above computed? (Include the estimated amouat of any prospective injury or damage.) 8. ?dames and addresses.owitaesses, doctors, and hospitals: 9. List the expenditures you made on account of Ibis.accident or injury: DATE TU,,4E AMOUI\IT 2p 11 tl� ,257 y. �,��� �° ;,RRakk SR■:k�/IJ /a ■Bra aRG.IFRRnice R,IA�RRR 4�f!1f,2i�R�T.�11�rnkY.R RR'w IJ S-. 'y"re S-:xSs!zCL".�..". CCSrR= .Gov. Code Sec. 910.2 provides "The claim shall be signed by the claiman or by some person on his behalf." SENDNOTICES TO: `Auorne-0 Dame and address of Attomey } (A.c ess) Telephone No. }Telephone No. ff 1MEN k Ram son as ss as s■■■RRn a am•R R a a s RRzRR;RR;Rs am MR aRIR■kkkR■■■k s RR Rkk kmMM RsMEN k RlRSRS Ri PUBLIC RECORDS NO'T'ICE: PIease be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the C- iifornia Public Records Pct (Gov. Lode, §§ 5700 e[ seq.) Furthermom, auy attachments,addend=s, or supplerneuts attached to the claim form,including medical records, are also subject to public disrIoswe. ■Rkkkkkk■=kRRztaz.kkz■.R■ISks k Mammas[■k■kks■kzz an k k kkass RRR RRRSRRRRRSRYR■R■RR SR REM MKEF NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to my state board or otTicer, or to any cotmty, city, or district board or officer, authorized to allow or pay the same if geauine, any false or fraudulent claim, bill, account voucher, or vTitin- is punishable either by 1mDnsoumeut in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars (SI,000.00), or by both sucb imprisonment and fine, or by imprisonzt=t jn the state prison, by a fine of not exee!&-ig ton thousand dollars ($1.0,000), ar.by both such imprisonment and fine. ses P061 California State Qr Automobile Association B e ® Inter-Insurance Bureau , wrw¢v Bow��ges P.O.Box 920 02 1M $ 00.420 Suisun City,CA 94585-0920 0004246209 JUN 02 2008 AILED FROM ZIP CODE 8091 9 RECEIVE® �21 JUN 0 4 2008 G s� CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. r�, L E;;,;+i2:—*-: ;D-Joi CLAiM .BOARD OF SUPERVISORS OF CON"rRA COSTA COUNTY BOARD ACT1ON:J U-� Claim Against the County, or District Govemed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The.copy of this document mailed to California.Government Codes. ) you-is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), JUN 1 1 2008 given Pursuant to Government Code Section 913 and 915.4. Please note all AMOUN"f: 7$igfw, COUNTY COUNSEL 'Warnings" MARTINEZ CALIF. CLAIMANT: Al erl ATTORNEY:I'�bY�(a(1 f:• �f}III� DATE RECEIVED: -tile. At-1-6 tau) ADDR.ESS:5�5 �_11 e 3r r,-, BY DELIVERY TO CLERK ON:`J ' &i1 ,� � cA %,t6BY MAIL POSTMARKED: r\.`oj FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a.copy of the above-noted claim. �� '' JOHN CUL�N, leir�kDated:�Ju.n� it, 2 By: D iI. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: �p—/ `o By: Ir Deputy County Counsel 111. FROM: Clerk of the Board .TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and coirect copy of the Board's Order entered in its minutes for this date. Date d JOHN CULLEN, CLERK, By eputy Clerk WAR N (Gov. code section 913) Subject to certain exceptions,you have only six(6) months from tile date this notice was personally served or deposited in the snail to file a court actiat on this claim.See Goverimient Code Section 945.0.You may seek the advice of an attoiiiey'of your choice in connection widt this matter. 11'you want to consult an attorney,yoti should do so immetliately. *For Additiaial War nhi ;See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as.shown above. Dated: to ? 1210 �JOHN CULLEN, CLERK By Deputy Clerk I Robert S. Arns, State Bar No. 65071 Morgan C. Smith, State Bar No. 168146 �fiEC' �® THF. ARNS LAW FIRM 3 A Professional Corporation JUN 0 .6 2008 515 Folsom Street, 3`d Floor Fi BOARD OF SUFcRVISORS San Francisco, California 94105 CLERK CONTRA COSTA CO. 5 Phone: (415) 495-7800 0 Fax: (415) 495-7888 7 Attornevs for Plaintiff 9 IN "THE SUPERIOR COURT OF THE STATE OF CALIFORNIA lU IN AND FOR THE COUNTY OF CONTRA COSTA II 1, NEIL CLAYTON; ) Claimant, ) Claim No. 13 ) GOVERNMENT CLAIM FORM 14 vs. ) [Gov. Code § 9101 15 CONTRA COSTA COUNTY, CONTRA ) COSTA COUNTY PUBLIC WORKS ) 16 DEPARTMENT ) 17 ) .Defendants. ) 18 ) 19 20 1. The name and post office address of the claimant is: 21 Neil Clayton -- 938 Chianti Way 23 Oakley, CA 94561 24 2. The post office address to which the person presenting the claim desires 25 notices to be sent is: 26 '7 28 -I- GOVERNMENT CLAIM FORM I Morgan C. Smith The Arns Law Firm 515 Folsom Street, 3' Floor 3 San Francisco, CA 94105 4 3. The collision which gave rise to the claim here asserted occurred on January s f 10, 2008 on Main Street, .2 miles West of it's intersection with Big Break Road, ill the 7 City of Oakley, County of Contra Costa, State of California. s - 4. On or about January 10, 2008 Claimant Susan P. Clayton was driving her vehicle 9 1() Eastbound on Main Street, .2 miles West of it's intersection with Big Break Road, in the I I City of Oakley, County of Contra Costa, State of California. Justin Gregory Callen was I driving his vehicle Westbound on Main Street, about .2 miles West of it's intersection 13 14 with Big Break Road, he lost control of his vehicle, crossed the roadway and struck 15 claimant's vehicle head on, causing injury to her person, damage to her property, and 16 causing her to sustain wage loss and substantial medical and other expenses. Claimant 17 IS Neil Clayton was, at all relevant times herein stated, married to Claimant Susan P. 19 Clayton. As a direct and proximate result of the injuries sustained by Claimant Susan P. 20 Clayton, Claimant Neil Clayton suffered the loss of the consortium of his wife, Susan P. 21 22 Clayton. 23 5. On or about January 10. 2008 and prior thereto, The County of Contra 24 Costa, The Contra Costa County Public Works Department, their employees, agents and 2; 2r, assigns, negligently and carelessly designed, constructed, altered, (ailed to alter based oil ?% new and different conditions, repair, own, maintain, controlled, supervised, or operated GOVERNMENT CLAIM FORM I the roadway commonly known as Main Street, in the City of Oakley, County of Contra Costa, State of California so as to legally cause and permit the said roadway to be in a 3 d dangerous and defective condition. Said roadway was dangerous and defective pursuant 5 to Gov. Code Sec. 835 in the following manner: 6 6. Said roadway was defective and dangerous in that the roadway did not have dividers protections' _guardrails, °warnin s, _miarkin s, signage arid"`` x proper barricades 9 other appurtenances in the area where the subject incident occurred. Additionally, 10 claimant is informed and believes that the super-elevation of the road was not in 11 12 accordance with the design specifications, and was dangerous and defective. 13 Additionally, claimant believes the road did not extend to proper widths as called for in 14 the relevant drawings, nor did the road conform to existing safety regulations for such 15 16 roadways. 17 7. Claimant is informed and believes that the public entities listed above were 13 responsible for the creation and persistence of the dangerous condition as 19.. aforementioned. 20 21 8. Said public entities had actual and constructive knowledge as defined by Gov. 22 Code § 835.2 of this dangerous condition, as such conditions were open and obvious 23 ,i and said public entitles regularly monitored the area. 2-5 9. Said public entities failed to protect this area from the obvious hazard and 26 dangerous condition by way of placing a guardrail or barricade or other devices along 28 -3- GOVERNMENT CLAIM FORM I the road edge to prevent cars from leaving the road area. Additionally, said public entity 2 failed to properly design or maintain the dividers or barricades between the Eastbound 3 a and the Westbound roadway to prevent cars that lose control from driving into the 5 oncoming traffic. 6 10. Furthermore, said publi c entities failed to modify the subject roadway when 7 ---- - conditions changed;--such as-an increase in traffic from L the-originals-design; increase ,in�•I_..=.,.,.•�ro.,. s 9 the speed of traffic froin the original design speed, and other changes to the existing 10 road and conditions that warranted upgrade. failure to address these changes in the road II 12 conditions represent an additional basis for liability pursuant to Gov. Code § 830.6. 13 11. Said public entities failed to warn the public regarding the hazard and dangerous 14 condition by way of placing signs warning of such dangerous condition and lack of 15 guardrails or barricades. Said public entities failed to properly design the area for the 16 17 safety,of those that were invited and/or allowed upon the land in the manner described 1s above. 19 20 12. l urthermore, said public entities by and through their employees, agents, and 21 assigns negligently failed to obtain appropriate approvals of said designs for such areas. 22 13. Furthermore, said entities by and through their employees, agents, and assigns 23 24 created a design that no reasonable employee or public entity would allow to exist as 25 described above. 26 27 28 GOVERNMENT CLAIM FORM. 14. Furthermore, said entities by and through their employees, agents, and assigns negligently failed to change said design when, changed circumstances demanded a i modification. 5 15. As a direct and proximate result of the negligence of the above named public 6 entities, their employees, agents and assigns, Claimant Neil Clayton sustained the loss 7 .--- .-. ....of-the=consortium-of his wife;Claimant, Susan-P.-Clayton► 9 16. "The name or names of the public employee or employees causing the injury damage or loss are unknown to Claimant at this time. 12 17. The amount of the claim exceeds $10,000.00 and the claim would be an 13 unlimited civil case. 14 PRAYER FOR RELIEF 15 16 Claimant Neil Clayton requests and demands: 17 1. Compensation for the loss of the consortium of his wife Susan P. Clayton; and 18 2. Such other and further relief as may be just and proper. 19 THE ARNS LAW FIRM 20 - 21 -- By: 23 Morgan24 q Yli Attorners -or Plaintiff 25 ,6 ,; ,K GOVERNMENT CLAIM FORM CLAiM BOARD OFSUPERVISORS OF CONTRA COSTA COUNTY `V �( c BOARD ACTION.�J(,l. Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) California Government Codes. The copy of this document mailed to . j you,is your notice of the action taken on your claim by the Board of JUN 11 ZOpB Supervisors. (Paragraph IV below), given Pursuant to Government Code t0 �� COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: ) MARTINEZ CALIF. "Warnings". CLAIMANT: W-150A EP. CLa y Ic-� 1 ATTORNEY: �09L1,11 G. 5f1,'LL�1 DATE RECEIVED: ��ung ZlTb b lJ PU P1515tau-) r�c m ADDRESS` ) I BY DELIVERY TO CLERK ON: (1W �DD� J � , Cqa�� C' i�o5 BY MAIL POSTMARKED: Ilk FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. i JOHN CULN, lerk. Dated{ l `� Zr�� By: Deputy . C I.I. FROM.: Cou ty Counsel TO: Clerk of the Board of Supervisors co/�Thls claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send waiiiing of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: r l.J Q By: Deputy County Counsel 111. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: d OHN CULLEN, CLERK, By puty Clerk WAR14(NGov. code section 913) Subject to ceitain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection wide this matter. Il'you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. am now, and at all times herein mentioned, have been a citizen of- the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage t'ully prepaid a certilied copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 19 q&WJ'JOHN CULLEN, CLERK By Deputy Clerk I Robert S. Arne; State Bar No. 65071 Morgan C. Smith, State Bar No. 168146 RECE ED THE ARNS LAW FIRM 3 A Professional Corporation EJUN0 .6 2008 515 Folsom Street, 3rd Floor 4 CLERK BOARD OF SUPERVISORS San Francisco. California 94105 CONTRA COSTA CO. Phone: (415) 495-7800 ` v Fax: (415) 495-7888 7 Attorneys for Plaintiff s 9 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA Io IN AND FOR THE COUN'l'Y OF CONTRA COSTA Il 12 SUSAN P. CLAYTON; ) Claimant, ) Claim No. 13 ) GOVERNMENT CLAIM FORM 14 vs. ) [Gov. Code § 9101 I; CONTRA COSTA COUNTY, CONTRA ) COSTA COUNTY PUBLIC WORKS ) 16 DEPARTMENT ) 17 ) 18 Defendants. ) ) Iy 211 1. The name and post office address of the claimant is: 21 Susan Clayton 22 938 Chianti Way 23 Oakley, CA 94561 24 2. The post office address to which the person presenting the claim desires 25 notices to be sent is: u, 27 78 -I- GOVERNMENT CLAIM FORM 1 Morgan C. Smith The Arns Law Fir1!n 515 Folsom Street, 3'd Floor 3 San Francisco, CA 94105 a 3. The collision which gave rise to the claim here asserted occurred on January 5 6 10, 2008 on Main Street, .2 miles West of it's intersection with Big Break Road, in the 7 City of Oakley, County of Contra Costa, State of California. Is 4. On or about January 10, 2008 Claimant Susan P. Clayton was driving her vehicle 9 Io Eastbound on Main Street, .2 miles West of it's intersection with Big Break Road, in the I I City of Oakley, County of Contra Costa, State of California. Justin Gregory Callen was 12 driving his vehicle Westbound on Main Street, about .2 miles West of it's intersection 13 14 with Big Break Road, he lost control of his vehicle, crossed the roadway and struck 15 claimant's vehicle head on, causing injury to her person, damage to her property, and 16 causing her to sustain wage loss and substantial medical and other expenses. 17 Ix 5. On or about January 10, 2008 and prior thereto, The County of Contra 19 Costa, The Contra Costa County Public Works Department, their employees, agents and 20 assigns, negligently and carelessly designed, constructed, altered, failed to alter based on 21 new and different conditions, repair, own, maintain, controlled, supervised, or operated 23 the roadway commonly known as Main Street, in the City of Oakley, County of Contra 24 Costa, State of California so as to legally cause and permit the said roadway to be in a 25 26 dangerous and defective condition. Said roadway was dangerous and defective pursuant 27 to Gov. Code Sec. 835 in the following manner: 28 GOVERNMENT CLAIM FORM 1 6. Said roadway was defective and dangerous in that the roadway did not have 2 proper barricades, dividers, protections, guardrails, warnings, markings, signage and 3 4 other appurtenances in the area where the subject incident occurred. Additionally, 5 claimant is informed and believes that the super-elevation of the road was not in 6 accordance with the design specifications, and was dangerous and defective. 7 8 Additionally, claimant believes the road did not extend to proper widths as called for in 9 the relevant drawings, nor did the road conform to existing safety regulations for such 10 roadways. Il 12 7. Claimant is informed and believes that the public entities listed above were 13 responsible for the creation and persistence of the dangerous condition as 14 aforementioned. 15 8. Said public entities had actual and constructive knowledge as defined by Gov. 16 17 Code § 835.2 of this dangerous condition, as such conditions were open and obvious 18 and said public entities regularly monitored the area. 19 20 9. Said public entities failed to protect this area from the obvious hazard and 21 dangerous condition by way of placing a guardrail or barricade or other devices along 22 the road edge to prevent cars from leaving the road area. Additionally, said public entity 23 24failed to properly design or maintain the dividers or barricades between the Eastbound 25 and Westbound roadway to prevent cars that lose control from driving into the 26 oncoming traffic. 27 28 -3- GOVERNMENT CLAIM FORM 0 1 10. Furthermore, defendant public entities failed to modify the subject roadway when conditions changed, such as an increase in traffic from the original design, increase in 3 the speed of traffic from the original design speed, and other changes to the existing 3 road and conditions that warranted upgrade. Failure to address these changes in the road 6 conditions represent an additional basis for liability pursuant to Gov. Code § 830.6. 8 11. Said public entities failed to warn the public regarding the hazard and dangerous 9 condition by way of placing signs warning of such dangerous condition and lack of 10 guardrails or barricades. Said public entities failed to properly design the area for the iz safety of those that were invited and/or allowed upon the land in the manner described 13 above. is 12. Furthermore, said public entities by and through their employees, agents, and 1s assigns negligently failed to obtain appropriate approvals of said designs for such areas. 16 L- 17 13. Furthermore, said entities by and through their employees, agents, and assigns 18 created a design that no reasonable employee or public entity would allow to exist as 19 described above. 20 21 14. Furthermore, said entities by and through their employees, agents, and assigns 22 negligently failed to change said design when, changed circumstances demanded a 2; modification. 24 2; 15. As a direct and proximate result of the negligence of the above named 26 public entities, their employees, agents and assigns, Claimant Susan P. Clayton 27 28 -a- GOVERNMENT CLAIM FORM sustained injury to her person, damage to her property, and sustained wage loss and 2 substantial medical and other expenses. 3 4 16. The narne or names of the public employee or employees causing the injury 5 damage or loss are unknown to Claimant at this time. c 17. The amount of the claim exceeds $10,000.00 and the claim would be an 7 8 unlimited civil case. 9 PRAYER FOR RELIEF 10 Claimant Susan P. Clayton requests and demands: Il 1. All special damages incurred including but not limited to all wage loss, medical 12 13 expenses and transportation costs; 14 2. All general damages according to proof; and 15 16 3. Such other and further relief as may be just and proper. 17 Dated: June 5, 2008 THE ARNS LAW FIRM 18 19 ,1, By: MORG SMITH 21 Attorn y for Claimant 72 23 24 ni 26 27 28 GOVERNMENT CLAIM FORM CLAiM BOARD OF SUPERVi.SO.RS OF CON"r.RA COSTA COUNTY ' BOARD ACTION: �ut, Q.-OD Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT ✓✓✓ and Board Action. All Section e• The copy of this document mailed to California Government Codes. D you is-your notice of the action taken on your claim by the Board of JUN 1 12008 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code (G MARTINEZ CALIF. Section 913 and 915.4: Please note all A.M.OUNT: t,) "Warnings". CLAIMANT: ',mi w Lm ,ATTORNEY: DATE RECEIVED: Tum�� ,T $ ADDRESS: j021,0 &U&)C KBY DELIVERY TO CLERK ON: ay%G BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a.copy of the above-noted claim. C�� JOHN CULLEN, Clerk Dated: VVM Lk r.aCX� By: Deputy 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors (.This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to coiilply substantially with Sections 9,10 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not-timely filed. The Clerk should return claim on ground that it was.filed late and send warning of claimant's right to apply �•,�for leave to present a late laim (Section 911.3). (t.�Other: �e_ Ra Tl CRS J W 1+11 , ✓ +Kra 6`N U r _S_r rl on a4 (oU,,1_/y C— (ba 4Yr4 65.4 Dated: 69By: m Deputy County Counsel ill. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (✓� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for. this date. Dated: O__HN CULLEN, CLERK, By eputy Clerk WAR Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the snail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney ofyour choice in connection widr this matter. If you want to consult an attorney,you should do so immediately. *For Additional Warnii�See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a ,citizen of the United States, over.age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed'to the claimant as shown above. Dated: Q.4 0 ,9"'e"V JOHN CULLEN, CLERK By Deputy Clerk • Claim to: .BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented no later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in.Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. .D. if the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim by ) Reserved for Clerk's filling stamp Cc v, C. 3 E C E IV E® Against the County of Contra Costa ) or > 2008 District ) CLERK BOARD OF SUPERVISORS (Fill in name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above- named District iii the sum o.f S g OSo Rc-) and in support of this claim represents as follows: 0 - OF :.tee 0,v . 1. When did. the damage or injury occur? (Give exact date and hour) —.... d4sbvrc Co"f✓'c� C-0<,-[,a _ 2. Where did the damage or injury occur? (Include city and county) S t .44&cAeo( Pa p-e- 3. How did the damage or injury occur? (Give frill details; use extra paper if required) 4. What particular a or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Ppb} C-e-rrJOe+ec ' ,v e- Serq-eank Se-1 tZavnyv ,p,0. 1!5ee- aj�rjc-L ►tie..►1: 6. What damage or injuries do you claim resulted? (Give frill extent of injuries or damages claimed.) Attach two estimates for auto damage. :r�o,,A-do0r, GccS;,, and kt �e Ood re u;r S�� c��'-�li��►�h�- 7. How was the amoud claimed above computed? (Include the estimated amount of any prospective injury or damage. ) PcjriL14 (orwl.e �ro�N. L-�ow�es ke 1`x���SS C©�pv:t�d `f(Ae- cAmov.n�, 8. Names and addresses of witnesses, doctors and hospitals. e- C� ZDZ(o or, P,-Fk, 6vjn ,C9 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO : Attome or by some person on his behalf." Name and address of Attorney (Claimant's Sig. 2ozu ISrus� re K Or, (Address) P,44-s6,Jr s , C- Telephone No. Telephone No. $22 - F1 3O NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a tine of not exceeding on thousand ($1,000), or by both such imprisonment and fine, or by imprisonunent in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ) • - f, GjoC1✓' (.�7 i'T� Uva Q�o e-C4- 19 +t A i t ------- --�P--e'^e��-P, j l,�e c,�oQ.ri �..,��Irs L./`•�k S��.��fr,(_�_�_�__-_---__.___.__— ---�TGC_IS-r' Gi Ce h('�—S.�cr.��f-�t� i-4�1•.�_�t_(�-E7�✓' -------------------,. ----- —KA'k:� � Gt. — Cr __— _-. —�G.�,�Ce✓�.�__CJ} INL�/ I OCCA—1 ' irtJ r� _T �Cl _ 1 . 2001 Crow Canyon Road,Suite 120 San Ramon, CA 94583 Phone(925)237-3018 Fax(925)362-0228 DATE: 6/11/2008 PGormleV(&HssExpress.net QUOTE/CG# L291TAN..;v.--.wr....,._..x..a..w.... .:....ti.....- ...:... ..... 2'.i(;`. ..#x'y": t::.•..:,s.., ••� ,.'',.'. Jalene and Billy Claraty 2026 Brush Creek Drive Pittsburg,Ca 94565 =Fres't WSA I = `'=:I r�� 925.808.9189 925.822.8130 Make Checks Payable to Homesite Services,Inc Bclaratvtao.9mail.com ;... Patrick Gormley Door Repair 500/o Due for Deposit] .yr .® :... .... = Remove secerity screen door,exterior trim,interior casing,and entry door.Install new entry door,and new 1 interior casing.Reinstall exisiting exterior trim,secerity screen door,and all exisiting hardware.Prep and $805.80 paint.Price includes material and labor HOMEOWNER TO SUPPLY PAINT CODES SUB TOTALoY TOTAL 50DEPOSIT DUE $ 402.90 % BALANCE DUE @ SERVICE END. m 71yank you for your business! - --- CLAIM � O 2_,oa g BOARD OF SUPERVISORS Of CONTRA COSTA COUNT. n 1 BOARD ACTION: C' Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document maied to California Government Codes. D you is your notice of the action taken on your claim by the Board of APR 2 3 2008. Supervisors. (Paragraph IV below), COUNTY COUNSEL given.Pursuant to Government Code AMOUNT: 2.��000, MARTINEZ CALIF. Section 913 and 915.4. Please note all r "Warnings". CLAIMANT: 1�1 Ob Dov ATTORNEY: 711f DATE RECEIVED: ADDRESS: ai _SSG L�- i"! v`e �V1 BY DELIVERY TO CLERK ON: ZL' occv_b.f I a Ok 46 b) BY MAIL POSTMARKED: C FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a co y of the above-noted claim. JOHN CULL G,le► ` (J Dated-, l By: Deputy �[.V�ZLILt:�ZI LCt L.�L� Z'� ti. FROM... County Counsel T0: Clerk of the Board of Supervisors 01 ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 91.0 and 910.2, and we are so notifying claimant; The Board cannot act for 15 days (Section 910.8). (�Cfaim is not timely filed. rrd s , (vr Other: C n,er bGGvrr.l v r a D .2, �12002 11ftMs r- �� �U ,� �DIIGGt lain -n fir 4c a lli_�R<r�, �YviY1 Lvv» Dated: `rte �y By: Deputy County Counsel i.11. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1.V. OARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date : ® JOHN CULLEN, CLERK, By Deputy Clerk WAIZ 1. (Gov, code section 913). Subject to certain exceptions,you have only six(6) months from the date this notice was peisonal} served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney,you should do so immediately. *For Additimal War nim b See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today .1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and NotWe to Claimant, addressed to the claimant as shown above. Dated: ivy, mer JOHN CULLEN, CLERK By eputy Clerk �IA��V/•1 .K.-�1� LTi- t .1� r� L.• r'�''� ..,y.fs�e� .:�..;..-. ` l f) b3--..i� t�ya' 04.11812008 0?:32 CONTRA COSTA COUNTY CLERK OF THE 96255592 NO. 2B4 Rb2 BOARD OF SUPERVISORS OF CONTRA COSTA COYIXW INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be fled with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed. by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form.' age me01rrrrmrrrrrerrr/rrrr/rrrrrrrssrrr/(so emu*aoverrrr'sr.mrs RE: Claim By: Reserved for Clerk's filing stamp Michael Davis ) ------;----- Against the County of Contra Costa or } _ ) i Child Support Services of Contra Costa '. (Fill in the name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named. C district in the stun of$ 25,000:oo and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) I From 2003 to present 2. Where did the damage.or injury occur? (Include city and county) Martinez Ca. And Oakley Ca. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Elizabeth Hoy commited purjury/Fraud in applying for Child Support 4. What particular act or omission on.the part of county or district officers, servants, or employees caused the injury or damage?The Child Support Division Admitted it was Fraud yet did not allow me to persue criminal charges. in Elizabeth Hoys crime against me and Tina Davis en they are r fusing tQ cpmp or deal with attorney (SEE ATTACHED) S What are the names of county or distnct o�fIcers, servants, or employees causing the damage or injury? Contra Costa County Child Suppogt Attorney IJ i ALSO Tina and I met with a worker at r'the Child support. division who said that Elizabeth ' Hoy hAD committed Fraud but"it happens all the time" She told Tina and I,I am not responsible for the money owed and she m would adjust it,but until then I had tm make payment or I would .loose my driversx License. (SEE ATTACHED) CONTRA COSTA COUNT'' CLER'r: OF THE 96255,592 140.X84 D03 6. What damage or injuries do your claim resulted'% (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Over 20,000.00 in Child Support FEe's and 2000.00 dollars in Attorney Fee's in which I contacted .. .)they .counties who said Chi14 Support Services s�oulq of taken card of�l Fraud s tf and b?ddr n>FER�3�}�ismissed. 7. How was the amount c acme above compute e prospective injury or damage.) The Money I was charged Child Support when the Child Support was awarded unlawfully and the County Admits it yet refused to protect me and Tina from this crime.And Lawyer Fee's I should not MW of had to pay. 8. Names and addresses of witnesses, doctors, and hospitals: See attached Documents and court records and the applications and laws in child support 9. List the expenditures you made on account of this accident or injury:- pATF� 71ME AMOUN1 Current Bill over 20 000.00 Approx 12/07 2,600.00 From 2003-present A rox.3 000.00 total ...................................................��...r■■�i..eemeeassetseeee..r■.Mel ) Gov. Cod-e-Sec. 910.2 provides"The claim shall be )signed by te c18i ant or by some person on Itis behalf." SEND NOTICES TQ: (Attorney) 1. Name and address of Attorney ) �t (Claimant's Signature) ' 2981 Saddle pu Oakley Ca.94561 ) (Address) ) Telephone No. )Telephone No. 925-625-0388 8 see systems se see ere seem of mmmeeeeerseeee eemere mseeemee srmmmr..........mese..re rree■r, PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim Fled with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, 99 6500 et seq.) Furthermore, any atwchments, addendum&, or supplements attached to the claim form, including medical records, are also subject to public disclosure. eesboom esererseesesseems em■is.memseeresee ■serr■rmm■■eeerermrereerrr.■■.meIt.a.re..erte, I NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any stnte board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment ,n the County jail for a period of not more than one year, by a fine of not exceeding one tliousand dollars (81,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. n4;18/'1006 09. 15 TEL 925 646 4583 DA SPECIAL_ OPERATIONS Z 003/003 s CONSUMER, BUSINWSS, AND INVeSTMENT FRAUD COMPLAINT FVIM CONT11A COS COUNTY DISTRICT ATTORNEY - SPECIAL OPERATIONS DIVISION P.OBox: 670, Martinez, CA 96553-0150 ��}X r " . PLCASE PRINT bR TYPE, IF POSSIBLE 9; g-6 y 6:-(4(,8 S Contra Costa County Department of Child P[_ Sqp , , 55 0 �?O�ug Bas Dr.Suite 100 NAIIf�d/BUlINCl1 OA RSOM COMPLAINED 0/ PHONE H 5300 ........................................ Martinez........,.Ca............9ASla...... . EPYOMC NVNBER (,ajY BSaa ZLT 2803-Pres„egt..Vin..QQ;ltra..Costa..Counter........... .......................... - ,. DATE AND PLACE 01 TRANSACTION Child Support. Fraud by,El VICi.� t,)�,,)� y............... In Child Support jCourt Fi leS, NAME 61•PiOCUCT 011 BERE INVOLVED MAB CQ MFRS GT f16MGC}OF!0,ATTACH COPT Of CONTRACT Vatious times over the las't 3 years,.until.,the present OATC AMO LOCATION 10490C NONEY PgIP IP PRMDUCT OR SERVICC AOVRRTIrRO: WNCM MNCRE ......................................... ...... IATTAGM COPT OF AO COMPLAINT INVOLVES M16REPREECMTATIONE I 0 AOVCRTISED 0 ORAL 0 OTHER 1 BCLOW) PAYE YOU CONTACTED A PRIVATE ATTORNEY? .XAS.. WHO? ..Many............................ ..... EXPLAIN FULLY' IDESCRIDC CVCNTJ IN THE ORDER IN WHICH THEY HAPPENCO If POSSIBLE, ATTACH CXTRA INCCT If HECEraA Rr.I This all started out a Child Custody case in 1tr 1994 where I recievd custody of my son at 5 mo of age due to him being burnt/beaten while with his mother Elizabeth Hoy. I had full legal and physical custody until 2000 when a .Attorney and Judge came on my sons Custody case who absolutely hated me. Elizabeth Hoy who had been making false allegations since 1994 to try to get me arrested to get custody of the child back. (See L1uii"2,it L and P l ,for a better understanding of the history of this cas( In 2003 11,7as living in Wa. State and this was Stated in a Declaration written and signed 'Dy Elizabeth Hoy dated 2/5/03 (EXHIBIT A ) . At this time Elizabeth Hoy and hE Husband Tom Hoy . ,. _.: were making false allegATIOns to have me arrested.At this same time Elizabeth Hoy applied for child Suppoet in Contra Costa County where neither of us or the Child lived.On Approx.6/14/03I was arrested in Wa State to be extradited back to California. (see Exhibit B ) ,I ended up in Canada where I was held from 9/03 until 11/03/2003. (Exhibit C) SEE ATIIACEPEIVT TO CONTINUE NAMES AND ADDRESSES OF OTHCR WITNESSES ..Ti. .Aavza.N75„QE.Tt:P 1,B1Vd..#245.,Brentwood California,9451.�..1- 1,P- 4�-.$73.R...................................................... THIS COMPLAINT MAY BE SENT TO THC COMPANY COMPLAINED ABOUT, I SUN TO PILC A COMPLAINT AGAINlT THE COMPANY NAMED ABOVE. 1 UNOCRSTANO TMAT THE OUTRICT ATTONNCY IS UNABLE TO AEPRUlwT PRIVATE CITILCHB lClRINO TNC ACTuIIM Of THEIR YDNET OR OTHER PERiOYAt REMEDIES. 1 AM,YOwevE R, PILING THIS COMPLAINT TO NOTIFY TME OIIITAICT ATTORNEY O/THE ACTIVITIES OF THIS COMPANY. Michael Davis 298-4-�Saddle DR. COMPLAINANT'S NAME....... ................................. .SI9E8Z I1E• .. ,.,................................ 1-�25-525-Q1388 Ckk1lay..C.a� ..9g5 .3....... ... .... ............................ ..................... TELEP NONE MUNI C1* RESIOEMG4 AND BUrINCtL! CST pAT. ..................... BIOME. ......'.. .................................... VA_ru WHITE COPY DIBTRICT ATTORMCY YELLOW COPT COMPANY OR POLICE AGENCY PINK COPY COMPLAINANT Continue page 2 Fraud Complaint form CCC.DA. Special Op's I was then extradited back to Martinez Ca. (Exhibit D ) and held there until 3-28-2006. That is when I was sentenced on Amended Charges (Exhibit E,read the bottom of this document) (I beat all the charges I was arraigned on) The.only problem I was never formally charged with the Amended charges or arraigned on them(Exhibit F„Judge states the amended charges do not exist) I was then released on June 12 2007 (Exhibit G) . The only way I found out about the child support is my Mother received a collection notice, I later found out after my release.that the State was taking my X-wife Tina Davis's tax money and Elizabeth Hoy called my mother(Margaret Davis 1-925-625-0388) about the checks and Liz knew I was in Jail. (Here is where it gets weird, the State claims to of served me through Tina in 2005,Tina never can verified she got served plus Tina was not my Legal wife at the time, I have never legally been married to Tina,just found this out, plus service to Tina was improper)Then before my release Elizabeth Hoy went to Butte County applied for a restraining order ,I never got a chance to defend myself on, I sent for a copy of the papers she filed , she lied/purged herself saying there was not an ongoing Child custody case in another County or orders,there was in Contra Costa, she stated I came to her house in 2001 and threatened to kill her and her family,yet in case#D93-00892 in Contra Costa or in the Sheriffs log this complaint does not exist, Around 12-2001 (I believe this is accurate date)Liz Hoy tried to get a restraining order in Contra Costa which she was denied and in that application she never mentioned these threats. see Exhibits_Land M ,where Liz Hoy has made allegations for years trying to get me arrested to keep me from my son and gain custody of the child and try to get money from my family and. stating she dreamed to separate my son and I have him for her and her husband.(all credibility issues) . 1(Go to Exhibit H)Elizabeth Hoy had to fill this out to get support, neither of us lived in Contra Costa and she knew it,I have many ways to show this, she knew I was in jail and it was her responsibility to let child support know that, but Liz had the state taking Tina's money (Who I was separated from at the time getting divorced.)(Liz Hoy then applies for support in another county, Butte(stating to Butte county I had income where Butte was charging me $300.00 a mo when I was incarcerated ,yet Butte dismissed that case)Now my contractors license is getting revoked,(Exhibit I) Contra Costa County Child support also said to pay the interest or they would take my drivers license even after they told me this was fraud, I am a victim of a crime so to deal with it I must pay or I loose my license, It does not make sense. I was told by an local Attorney, a family court clerk was circulating a picture of mine around in the court and she could not represent me, then ever single Attorney I would contact agreed to do my case but within a week they called me and told me they could not.)(Some Attorneys would call back and say they were booked, We would call that attorney later, not saying who I was or have a women call and all the sudden they were not booked, I then filed a motion to have the child support money removed due to fraud since the girl at Contra Costa County told us it was fraud,I had a court date, then went to San Francisco and hired an attorney before he had a chance to talk to anyone in Contra Costa(I Barrowed the money)Also I fear appearing in Contra Costa court due to the way I was treated in my child custody case since 2000 and my probation case, I do not want near that place, I do not want near Liz Hoy,All I want is for to quit this harassment raised my child by myself for 10 years and she never gave me a dime I do not mind paying for my son, but this money was illegally and unjustly assessed (. It was also the advice from my G family and friends to stay away from the court because they are afraid for me as a matter a fact I want to move from Contra Costa county ASAP.) The attorney M.Tilden Moschetti told me and the person I was with that there is no way I owe that money and that Child support places usually work with attorneys but Contra Costa.County would not work with him on my support case(Exhibit J-1)A fax from Tilden to me. Then I talked to Butte County and other Counties and they all said it is the Counties duty to take that money off and address any fraud. (Child support case# F03-02552 court case# 7190460) Then my Attorney talked to the court and Contra Costa child support, he misses the court date telling me it was due to traffic. I am receiving Monthly billing statements(Exhibit J) and my family and I are afraid Contra Costa County will use this back Child support to have me arrested and/or keep me tied up in the system. I called the Sheriff's dept , to make a complaint due to this concern and others. I had an incident report made which is # C081100759(Exhibit K for copy of that# and the officers card)Earlier in the week 1 called Special Op's in the D.I.. office,the Special op" lady said they would sure pressure the child support division to take care of this.(I cannot go to family court,they did nothing but lied about me .my family and child since 2000, How is that in the best interest of our children, Why would I go to a place where they lied and when I prove it, the Judges do nothing about it and if you complain or prove they lie,they lie to put you in_jail and I.just do not know how-that is about our children, and on top of that the family court clerks are passing flyers around with my picture on it which is discouraainp- counsel from representing me.then my family member tells me they know a court officer and she said the Judgcs ail hair�M, ,I h avc co�i�c to u'�e reality it was planned all along lily son and I would suffer and not see each other until he is IB.; It is clear I have no rights in Contra Costa. this was also said in my probation case. I have never harmed that child yet he was beat and burned .hospitalized and used as a pond by his mother to collect money. and most of all the psychological damage this has on my son and the lies he is being told. I proved in court, family and criminal these people lied over and over and if this complaint is pursued I will bet Elizabeth Hoy or some one else will start. making false allegations again against me to try to have me arrested, so she is never held responsible. But if I do not pursue it Contra Costa County will arrest me for being a dead beat Dad for money I do not legally owe and have no way to pay, I also asked for Contra Costm let me appear in court while I was incarcerated but Judge Berkow denied that. 1 '^ad her dismissed off case 4l 2 ase m � Attorney e u �a male a- n rr D93-0089 becai.�. } said she would �.�i st me. she disliked me. Once she was removed 5 other Judges gave me fiall custody I do not know how any Judge '-n contra Cncta ren ati?it`ql;Jr nr t»,,cases du? Tl TfSP events,inr.e 2(100_ Contra Costa County Child support will not assist me and from what my attorney said they will not work with him.. I am a victim of fraud and should not have to hire an attorney when contra Costa county child support has all the proof they need to verify. 1 was incarcerated and Liz Hoy applied in a county neither party lived in. Contra Costa County should of adjusted these fees months ago. Every other county in this state tells me Contra Costa should adjust the fees, as a matter of fact the girl who works at child support told Tina and I she would adjust the fees, she never did it. Many people involved in Contra Costa Court have an axe to °rind with me acid will not let it ao. i wt[) uta;u4 HI'I IIK, wr r OOJ O l U`t P'L�1t]r lDRtin OR vl+RTY Nlrrff011T ATTORNEY(Nemc4'a6ArOx rRtn10sr,ane edbaaof_ FDA cGY)wr aw GMLT P. Cine C(D t CD- g57q)-7 - ios-Z TEIFPHONENO_5-iO 3q.Z-9g8q PAXNO_ A7RNSY FOR(Nam W: a:7 j() G(1 SUPERIOR COURT OF CA IFORNIA,COUNTY OF Cnatro-, C cs-+Ck 6TREETADDRESO: 7 XS MAILIND ADDRESS: l ; (J Q L) /� 4 CRY AND TIP CODE: ,�^la'(k`f\�Z1 I CCL. "L/S'S.3 BRANCH NAME•, '�` , PETIT10NER/PtAINTIFF: �}(�1C.lnG► 1 p�V RESPONDENT/DEFENDANT; , RESPONSIVE DECLARATION TO ORDER T HOW CAUSE CABENUMBER: OR NOTICE OF NOTION J� Q HEARING DATE: TIME: DEPARYMT.Z OR ROOM: D q3 1. I CHILD CUSTODY a. M I consent to the order requested. b- I do not consent to the order requested but t consent to the followirg order L O�'�l r1 l�l'� (.',J i� •��l 51 (11 C. '��,��C��'.�1���--•�.�� �C�(.L� - -F�'�t' be t�•��� ���C S ��Q ��(�1+S ed V t s 1 A-5. 2. CHILD VISITATION a. 0 I consent to the order requested. b-,50 I.do not consent to the order requested but 1 consent to the fallnwing.ordar. 3.[-1 CHILD SUPPORT a_ 1 consent to the order requested. b. O. 1 consent to guideline support. c. I do not consent to the order requested,but I consent to the following order. (1)Q Guideline (2) tither(spedfy): 4, O SPOUSAL SUPPORT a. 0 I consent to the order requested. b. I do not consent to the order requested. a L] I consent to the following order. S. O ATTORNEY FEES AND COSTS a. I consent to the order requestdd. b. I do not conserd to the order requested. c. Q I consent to the followLng Order: _Pw.%ms Form AaoDrae kr Wrta.tory Lies RESPONSIVE DECLARATION TO ORDER TO SHOW CAUSE Ju0.ctel CaunaU of ml° FL-3:0[Rev.sv,Jcrtuory ry 1.1,300.91 OR NOTICE OF MOTION -NPP'-My yran�rac erer -- Page 2 of t zuuj wtu uta;nq till nK, ltur T eiu 000 0104 V• UJ PETITIONEFOPLAuFFF CAMNNUMBOL ,1 RESPONDENT/DEFENDANT: A-1 1 Z: F(C J 3 O v 6. Q PF 40PE-RTY RESTRAINT a. I consent to the order requested. b. I do not consent to the order requested. a [� 1 consent to the following order. 7. Q PRAM CONTROL_ a. I consent to the order requested. b• I do not consent to the order requested C. I consent to the following ander 9. CI OTHER RELIEF a. 1 consent to the order requested. b• d I do not consent to the order requested r— [] i consent to the following aider 9. 96 SUPPORTING INFORMATION contained In the attached dedaratfon. NOTE:To respond to a request for domestic violence resmining orders requested!r;.i;;r) :•'err- for Omar(Domestic Vlnlence Prevention)(form DV-100)you must use the Answer to Temporary Aev&vkrMg Omer(Domestic Vlalence Prevenf m)(form DV-12o I declare under penalty of perjury under the Iowa of the State of California that the foregoing Is true and correct. Deter OWE of POW 9"4 IBK�w►TuriEof oEctapMiF> FL-=Plaw-AanumuV,.sanl RESPONSIVE DECLARATION TO ORDER TO Sf40W CAUSE Pea.a z OR NOTICE OF MOTION htty://www.mypyramidtracker.gov/DefaulLaspx?Module=21 10/25/2007 P JJV VVJ V!V'7 " vT UJ LUUJ WL:V UV'JJ 1-111 1111, AVI 1 - ••- --- - •- Davis VS Hoy 2/5/03 ATTACHMENT RESPONSIVE DECLARATION TO NOTICE OF MOTION I, Elizabeth Hoy, mother of Michael Aaron Davis - minor, declare under penalty of per ury as follows: RELOCATION I would like to, first of all, offer this court and the most honorable, Judge Craddick, my most sincere and heartfelt apologies for having moved without prior approval. I assure that the move was considered in great detail. Please take into consideration that I moved my family to the East Bay Area in 1999 to be close to Mikey's father, so that we might co-parent in some way. Mr. Davis moved to Washington. Nfficey successfully completed his school year, his baseball season(making the only homerun in the whole division) and his Cub Scout season. r , HOOKWGS FOR DAVIS,MICHPLFL ACK. X.; t Q © on odd 0ite-ift- J Led NNW ALyi; Birth tnrormauo�n Frd Nems InICHAEL 008 ® A*b Nmw .tAm em cky. lukLmff Calot BYRE Stdec F�;p Nick Now mrlaStdus yE— �. SSk SE�o-7-569! F� E?1 301[!11 SR A21i55341 - IN .p: _ ,ter.'_. 'i,..•.- - -- — .. - .. r _ ,.x •.:c:�'� - ;•,3r: fry, - - •+~ .HOI/b:i: ''{r'',' ii4c'X -�?�. •P11ri11t'.0 F1R.:: •'4ChocWbt,Im .. . . 1 OBII4ODOe:t9 OBMQWltW ILCMWvILW WJwL .r AT fir. pc .]rte' _ .. - i*r;': '.i'•:.'. ':`:'' r } lk rya*,' , �•• '? ,. .�, . • r , L: a r.: w,5.. 4;. 5V:�;>i�rad: ;.i�z•-,.���' .r rfr;;:r: :r• ..� r. .'.r. • '..4". TV .!' .�LM�• ,1,-..•• .d ''L:..Y ''r''L' -__�fi' W. •s D'1- 7 .:J�. :fir (• .1: "� — '�F' - -s r• v'' c v Alban SOLICITOR GENERAL AND PUBLIC SECURITY Correctional Services 12200 851"Street NW Phone: (403)695-2100 Calgary Remand Centre Calgary,Alberta Fax: (403)695-2079 T3R U3 DATE: April 4, 2008 TO: WHOM IT MAY CONCERN RE: NAME: Davis, Michael Jack D.O.B.: 1960/09/29 S.I.N.: N/A Please be advised that our records show the above named was incarcerated for the following period(s): Admitted to Calgary Remand Centre : 2003/11/03 Released from Calgary Remand Centre: 2003/09/26 Trusting this is the.information you require. K. Canning A/Director Calgary Remand Centre Cc: file CONTRA COSTA DETENTI.01Y.. Booking/Charge Report CIN: 70053243 Book Name: DAVIS , MICHAEL , J Book#: 2003025380 Booking & Arrest Summar-v: CIN: 70053243 Book#: 2003025380 Book Name(L,F,M,S): DAVIS, MICHAEL, JACK 3c,o c Dt/-r(1: '11-13-2003 2047 Reic-ase !D-W--n: 03-28-2006 0213 Release Type: STQ Warrants Check: Initial: C By:67036, COGO Dt/Tm:11-18-2003 2130 s'irne Served: Release: C By:41468, GARCIA Dt/Tm:03-28-2006 0212 2 yr 4 mo 9 dy 5 hr 25 mi HONORABLE BECTON SMITH ' D30 PV SENTENCING MICHAEL JACK DAVIS F DKT# 05-020388-5 DKT#05-011410-8 THE FOLLOWING PROBATION VIOLATION ALLEGATIONS WERE FOUND TO BE y7 {; �� Ali 3 TRUE: G AI.L� 4 1) THE ORIGINAL PETITION DATED 2/27/2003 ALLEGING: WHEREABOUTS UNKNOWN. L C> 1T► -.1 1. L�J1�� WlhJ�t 4 SUP1PLEMENTAUPETITION #1 DATED 3/19/03 ALLEGING: THE ANNOYING OR 7 7 HARASSING PHONE MESSAGES RECEIVED ON 2/26/2003 AND 3/14/2003 9 REGARDING COMPLAINTS AND VEILED THREATS TOWARDS JUDGE CRADDICK, 10 BILL ULRICH, THOMAS HOY, AND JOHN KIRBY. 5 i�L' C a°,: .I - 11 8)_SUPPLEMENTAL PETITION #1 DATED 3/19/2003 AL EGING: THE ANNOYING OR - -" - -- 12 HARASSING PHONE CALL TO JOHN KIRBY O 3/12/2003. L i Zc WQ 7V 13 4) SUP PLEMENTAL,PETITION #1 DATED 3/19/2003 ALLEGING: THE ANNOYING OR 14 HARASSING PHONE CALL TO �URICH 3/14/2003. 155)`SUPPLEMENTAL' ETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR 16 HARASSING PHONE CALL T BILL ULRICH-ON 4/16/2003. 17 6) SUPPLEMENTAL,PETITION #2 DATED 66/3/2003 ALLEGING: THE ANNOYING OR 18 HARASSING PHONE CALL TO OHN KIRBY N.5/11/2003. c. _ c-+u� tii� 7 k F ` 19 --7) SUPPLEMENTAL;PETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR 20 HARASSING PHONE CALL TO OH KIRBY ON /1�2/�03. i`QST f�� o ►,� Q st s 7 21 4 8) _SUPPLEMENTAL PETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR 22 — _— �_ HARASSING PHONE CALL TO BILL ULRICH N 5/20/2003. 24 THE rORIGINALrSU aL,_, TAL PETITI N TO REVOKE,PRO8AT4a TATED 25 THAT THE DEFENDANT IS TO HAVE �P CONTACT WITH JOHN KIRBY OR WILLIAM Y ULRICH, HOWEVER THIS WAS Ah/IEND.E�. TO•DO NOT-r�,h!°N 0Y,,,Q'RAARASS. THE .--(•vr?,".:.sJar"'�• ' T-1 - - -�?�- _•• .�°.-sem b .i unintelligible and delusional rant against alleged racism in the judicial system and the harmhis child has suffered. On June 29, 2005 the court also received a new Faretta motion and a-nation objecting to his probation report wherein petitioner disputes certain..Llaims in the pro-Ea-tron rep-- ort. A copy-of the instant petition was also lodged with those t o motions. Turning..pow ffp_all o his `etiti _n, petitioner claims e.t. �A vend 4Pyro bation f� Offcer,.l�ot _ d_de'( an�a enduiii to.his robation ie ort. The court h"as revrewed the un er yin clerk's file and.. inds.no:.sueFa.a.d,dendum inAhe court's file, a fact - acknowledge `bypefrtio.net #h:fparrapfY�.1."f' the petiti� efr inner makes additional ,. _ s ..: .. craims th tfhe has been::Vli:vol>zong u(fi" v.r�"10 a' ed-f32-Airnes and'�all the-violations were "manufactured." He claims he "beat" all these charges. Petitioner denies shooting at anyone during a child exchange. Petitioner denies harassing or annoying anyone. Petitioner further complains that the probation officer refuses to meet with him. Fjnally., petitioner requests a copy of the addendum to give to his doctor in order to obtain an "accurate report." The court has read and considered the instant petition and now denies it for failure to state any legal or factual basis for relief. Vague, conclusionary allegations will not support writ relief. (In re Swain (1949) 34 Cal.2d 300, 303 — 304.) The-cflu L ,9t furnish Petitio. er:' it um_ (} r � =e�cLsett=addend A' The titiohjs denied. Dated: ° Dan O'Malley, Judge of the Sup or Court cc: Petitioner 05-011410-8 Deputy DA Dominique Yancey, Esq. Maurice Moyal, Esq. Hon. Diana Becton Smith _ y t t \ jj/moss27t.doc �. a 2 �' til.\! III ( A1.'111(NIA ;! r CDC i I t Rel 05!0I) „II V,111 1 1 ! I, 1T. Iiv, Junp, 12 ''.(1(17 f'oi .1 pciiod of 3.years Thi; marc. is sub tet to the V i a _ ' , \r j fitllu\'nnnotice and cunditiuns. Should ti'ou violntc amrfitiul . r.l titin pan.le. ou arc ,ui1 cct w .111C-It. SuspcnSion amu relocation ol'vour mlrolc. : )it waive cxtaditiun to the State of California i'rum any state or territory ill the t-sited States or from the District of Columilia. 1'ou \'.ill I contest amt-ell4ort Io return Vol] to the State of C'nlifonlia. When the Board of Prison Terms deternlineS. based upon IlSychiau•ic rcosonS, that you pose it dalr-le• to yuul:Sell or uthcrs. tits Board nix.. neccssary lilt- psvcftiatric trcatnent, urdcr your placement in a corllrlrlrllity treaurtent facility or State prison or nlav revoke your parole and ere vour return tit prison. YOU and your residence:Incl any property uncle-your control may he Searched\villlout a will-rant by an agent of the Department o(C'nrrections or ally law enlurccnlcnt office. II'another jurisdiction has lodged a detainer against you, you may he released to the custody ofthatjurisdiction. Should you he released from th custody prior to the expiration of your California parole, or Should the detainer not he exercised. you are to iininediatcly contact the near Department of Corrections' Parole and Community Services Division Office for instructions concerning reporting to a parole agent. )'oil halve been inlorincd and have received in writing the proce(Iure.Ior obtaining it Certificate of Rehabilitation(4S52.21 PC1. L SPECIAL CONDITIONS 1NIU'•ST: a) Relate to the crime for whichyou were convicted, h) Relate to conduct %•hick is itself criminal_ c) Prohibit conduct which nlay be related to future criminality. )'oil are subject to the following special conditions: SEE ATTACHED ADDENDUM Reasons for the imposition ofspeciad conditions of parole: SEE ATTACHED ADDENDUM I acknowledge Illy Special conditions of parole:. . �,r O. o•) )�(� (p�0/6) �- I.4HrnFr5IN) ;ALS SmN.-\U)kYc)P1)NI'rS1lI'ItR\ :,)R DAII.';ItaJl:i� �. ��[.:.C,A.i i:, Iii:a�-VRi'iNi.:, i I:JiL vNSFS' AND iiU'OVxa.: UIi1C5S Vi,6cr Ul'rall,_cmcml are approved in writing, you %Viii repo)] lU VC parole agent on the first working clay following your release. Any change of residence shall be reported to your parole agent in advance. Y will inform your parole agent within 72 hours of any change ofenlploynient location,employer or termination of em)loylllelt. 3. PAROLE AGENT INSTRUCTIONS: You Shall Comply With all instructions ul'your parole agent and will not tra\el more than 50 nli from your residence without his/he' prior approval. You will not he absent fron-1 your COt1111y of residence for it period of more than 4S hon and not leave the State of California without prior written approval of your parole agent. 4. CRUMNAL CONDUCT: You shall not engage in conduct prohibited by law (state, federal. county or nnulic•ipal). You Shall i!tunecfiatr inform your parole agent if your are arrested for it felony or nlisdenleanor crime. Conduct prohihilel by law may rc>ult in parotic re+.oc:ui even though no criminal conviction occurs. 5. NEAPONS: You shall not own, use, have access to. or have under your control: (a) ant' t}I1e of firearm or instrument or device lvhicf reasonable person would heliCvC to be capahlc ol'hcing used as a fircarni or any a1111111UI11ti01t \1'hich could be used in a firearm: (h)any :neap as defined in state or federal statutes or listed in C'ahl'o nia Penal Code Section 12020 or any inztrument or dc\ice which re lsnnahle Hers would believe to he capable of being used as a weapon as defined in Penal Code Section 12020: (c) any knife with it blade longer than t' inches. except kitchen knives which must he kept in your residence and knives related to your employment which may he used and cirri only in connection with your employment; or(d)a crossbow of any kind. 6. You shall Sign this parole agreement containing the conditions of parole Specified in Board of'Prison 'hums (BP•r) Rulcs Sections 25121 any special conditions imposed as specified in BPT Rules Section 2513. Penal Code Section 3060.E provides that tflr 13PT shall revoke ) parole of only prisoner/parolee who refuses to Sign the Notice and Conditions of parole. )-oil have the riuht to appeal the Special conditions parole_ Special conditions imposed by the Parole and Community Services Division Inav he ::ppualcd pursuant to C'alifol-11i; (_GdC Regulations (CC_'R), Section 30`;4 and 1095. Special Conditions of parole imposed by the BPT mmy Ile aliilcnicd nur::uanl tit ( C'R. tiucti )050. I have relied or-have had read to me and understand tiie conditions of f::ta-ole as tltev apply to rile. i I)( NUNIHER I'Alt0l.[:I:NA\Ili(Prins ur'[%pc) I':\RUl.iiti SI(;N:\I I F22106 DAVIS, Michael TO BE COMPLETFD BY STAFF: — - - -- - - Docs the inmate pnrolec have a(.11111i`ying disahidity I-Cyuiriil"effective c•onrlllunieation° � 11."C s, If r1Z. CiIC:the Source d0CIIIll ent and/or oil servalions: What type nhacrommodalioniassisancr was provided to achieve elfcctile cr.n7nunicilliun to the hest of,tile inmate %parulcc's ability:' ,i.lf1 :ti:`.M1.11'rinlut i•.''rc) N5h 1 Lo. :1 1, S S ® CONTRA COSTA.000NTY Department of Child Support Services SUpporting Linda M. Dippel, Director California's Children 50 Douglas Drive, Suite 100. Martinez, California 94553-8507 Phone: (925) 957-730D FAX: (925) 335-3636 NONCUSTODIAL PARENT: APPLICANT'S PHONE NUMBER: Enclosed you will find the necessary forms to open a support case with the DEPARTMENT OF CHILD SUPPORT SERVICES Before you begin, please read the enclosed Child Support Information Handbook and the Child Support Enforcement Program Notice. They explain the services available and your responsibility to the Department of Child Support Services and the Department of Child Support Services' responsibility to you. WHEN YOUR APPLICATION IS COMPLETE Mail the package to: or Drop it by the office at: DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE, SUITE 100 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ, CA 94553 MARTINEZ, CA 94553 If you have questions, the number to call is (866) 244-5382 2404/MAY 05 CTAT DEPARTMENT OF;.HIED SUP-ORT SERVICES OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CHILD SUPPORT SERVICES PROGRAM NOTICE WHAT CHILD SUPPORT CAN DO FOR YOU: All children have the right to be supported.by both parents. Any person, including a noncustodial parent, whether or not he or she receives public assistance, can apply for support services. Some of the available services are as follows: • locating the parent(s) for support enforcement purposes; • establishing paternity (legal fatherhood); • establishing a child and/or medical support (health insurance) order;. • enforcing a child and/or medical support order; • modifying an existing court order for child and/or medical support; • enforcing a spousal support order in conjunction with a child support order; • collecting and distributing support payments. CUSTODY AND VISITATION SERVICES ARE NOT PROVIDED THE LOCAL CHILD SUPPORT AGENCY PROVIDES SERVICES ON BEHALF OF THE STATE OF CALIFORNIA. THEY DO NOT REPRESENT YOU AND ARE NOT YOUR ATTORNEY. BECAUSE YOU ARE NOT THEIR CLIENT, THE INFORMATION YOU PROVIDE IS NOT CONFIDENTIAL UNDER ATTORNEY/CLIENT PRIVILEGE. SOCIAL SECURITY NUMBER DISCLOSURE The information in your case may be discussed or given to the State, the Department of Child Support Services, other public agencies that can legally receive such information, and to the other parent or his/her attorney to the extent required by law. The local child support agency is required, .under Section 466(a)(13) of the Social Security Act, to include in child support records the Social Security Number of any individual who is subject to a divorce decree, support order or paternity determination or acknowledgment. Social Security number information is mandatory and will be kept on file at the local child support agency to locate individuals for the purpose of establishing, modifying and enforcing child support obligations. Enrolling a child in health insurance may require the release of the child's Social Security Number and mailing address to the other parent's employer or the release of the child's Social Security Number to the other parent. COOPERATION WITH CHILD SUPPORT When you request services, you must cooperate with the local child support agency by providing any information or documents needed to establish paternity and/or locate the other parent and to get support payments for your child. Once the services of the local child support agency have been requested, the local child support agency will determine the appropriate actions to take. All support payments must be turned over to the local child support agency. When you apply for, or receive, support services, you are responsible for promptly informing the local child support agency of any changes. in circumstance or information. Some examples are: child leaves the home; • telephone number or address changes (including a move to another State, County or Country); • stopping public assistance (CaIWORKs); • name change; • initiation of divorce or legal proceedings; • information regarding the noncustodial parent; direct receipt of any child, spousal, .or family support payment. 196(01/021- CHILE)SUPPOS T SERVICES PROGRAM NOTICE - Pa 1 2404/MAY 05 "' MEDICAL SUPPORT AND MEDI-CAL Every child is entitled to a court order that requires one or both parents to provide health insurance if health insurance is available at reasonable cost. , In general, the cost of health insurance is reasonable if it is employment-related group health, insurance or other group health insurance. However, in determining reasonable cost, the court Will also consider the actual cost to the parent(s) of the health insurance. The local child support agency will ask the court to establish or modify a child support order to require the parent(s) to provide health insurance if it is available at reasonable cost.- The custodial parent may also request that the local child support agency modify the child support order to include a provision for health insurance. This may affect the amount of the monthly. child support obligations. If the noncustodial parent is ordered. to provide health insurance coverage, . the local child support agency will contact the noncustodial parent and his or her employer, if necessary, to secure health insurance for the child. After the local child support agency receives the policy information, a copy will be given to the custodial parent. Having private health insurance coverage does not prevent you from having Medi-Cal coverage. If you receive Medi-Cal and have individual or group health private coverage (including dental or vision coverage), you are required by Federal and State law to tell your county CaIWORKs department, your health care provider, and/or the local child support agency. Failure to provide this information is a misdemeanor. You must report to your CalWORKs eligibility worker and/or local child support agency within ten days when your private health coverage changes or stops. You must also tell your CaIWORKs eligibility worker and/or the local child support agency about any court order regarding health insurance. If you are only receiving Medi-Cal benefits, you must cooperate in establishing paternity and obtaining medical support as a condition of continued eligibility for Medi-Cal benefits for you, unless you have filed and the County CaIWORKs department has approved a claim of "good cause" (CA 51 ) for not cooperating. Your children will still be eligible for Medi-Cal. Also, all child support services will be given, unless you tell the local child support agency that you do not want services that are unrelated to obtaining medical support and establishing paternity. Obtaining medical support may reduce the amount of child support you receive. In cases where both parents are in the home, the local child support agency will establish paternity only. Under Federal law 142 U.S.C. Section 1396A (25)) health insurance belonging to a Medi-Cal recipient in a child or medical support enforcement case is used .as follows: The service provider will bill Medi-Cal. Medi-Cal will pay the service provider. Then Medi-Cal will seek repayment from the other health coverage. You are not responsible for any insurance cost-sharing amount (co-insurance, co-payment or deductible) unless a Medi-Cal co-payment or share of cost must be met. The provider may bill you for the service if you do not cooperate in identifying your private health insurance. If your other health insurance is a Prepaid Health Plan (PHP) or a health maintenance organization (HMO), you must use the plan facilities for regular medical care. Except for out-of-area service or emergency care, Medi-Cal will not pay for services rendered by a provider not associated with your PHP/HMO. Out-of-area services or emergency care should be billed to the PHP/HMO. FOR MORE INFORMATION ON CHILD SUPPORT SERVICES PLEASE REFER TO YOUR CHILD SUPPORT HANDBOOK NONDISCRIMINATION STATEMENT It is the policy of the State of California to ensure that all individuals are treated equally and that no person shall, on the basis of ethnic group identification, race, color, national origin, political affiliation or belief, religion, sex, age or disability be excluded from participation in, denied the benefits of any program or service, or otherwise be subjected to treatment that is different than that provided to others. Each local child support agency has a designated Civil Rights Coordinator. Any applicant/recipient who feels they have been subjected to discriminatory treatment may file a complaint of discrimination by first contacting the local child support agency's designated Civil Rights Coordinator or by writing to the California Department of Child Support Services, Attn: Human Services Section, Civil Rights Office, P.O. Box 419064, Rancho Cordova, CA 95741-9064 or telephone (916) 464-5200. r :S 196 101/021 CHILD SUPPORT SERVICES PROGRAM NOTICE- Pp 3 2404/MAY 05 1 1 i Bank page MEDICAL SUPPORT AND MEDT-CAL Every child is entitled to a court order that requires one or both parents to provide health insurance if health insurance is available at reasonable cost. In general, the cost of health insurance is reasonable if it is employment-related group health insurance or other group health insurance. However, in determining reasonable cost, the court will also consider the actual cost to the parents) of the health insurance. The local child support agency will ask the court to establish or modify a child support order to require the parent(s) to provide health insurance if it is available at -reasonable cost. The custodial parent may also request that the local child support agency modify the child support order to include a provision for health insurance. This may affect the amount of the monthly child support obligations. If the noncustodial parent is ordered to provide health insurance coverage, the local child support agency will contact the noncustodial parent and his or her employer, if necessary, to.secure health insurance for the child. After the local child support agency receives the policy information, a copy will be given to the custodial parent. Having private health insurance coverage does not prevent you from having Medi-Cal coverage. If you receive Medi-Cal and have individual or group health private coverage: (including dental or vision coverage), you are required by Federal and State law to tell your county CaIWORKs department, your health care provider, and/or the local child support agency. Failure to provide this information is a misdemeanor. You must report to your CalWORKs eligibility worker and/or local child support agency within ten days when your private health coverage changes or stops. You must also tell your CaIWORKs eligibility worker and/or the local child support agency about any court order regarding health insurance. If you are only receiving Medi-Cal benefits, you must cooperate in establishing paternity and obtaining medical support as a condition of continued eligibility for Medi-Cal benefits for you, unless you have filed and the County CalWORKs department has approved a claim of "good cause" (CA 51 ) for not cooperating. . Your children will still be eligible for Medi-Cal. Also, all child support services will be given, unless you tell the local child support agency that you do not want services that are unrelated to obtaining medical support and establishing paternity. Obtaining medical support may reduce the amount of child support you receive. In cases where both parents are in the home, the local child support agency will.establish paternity only. Under Federal law 142 U.S.C. Section 1396A (25)] health insurance belonging to a Medi-Cal recipient in a child or medical support enforcement case.is used as follows:. The service provider will bill Medi-Cal. Medi-Cal will pay the service provider. Then Medi-Cal will seek repayment from the other health coverage. You are not responsible for any insurance cost-sharing amount (CD-insurance, co-payment or deductible) unless a Medi-Cal co-payment or share of cost must be met. The provider may bill you for the service if you do not cooperate in identifying your private health insurance. If your other health insurance is a Prepaid Health Plan (PHP) or a health maintenance organization (HMO), you must use the plan facilities for regular medical care. Except for out-of-area service or emergency care, Medi-Cal will not pay for services rendered by a provider not associated with your PHP/HMO. Out-of-area services or emergency care should be-billed to the PHP/HMO. FOR MORE INFORMATION ON CHILD SUPPORT SERVICES PLEASE REFER TO YOUR CHILD SUPPORT HANDBOOK NONDISCRIMINATION STATEMENT it is the policy of the State of California to ensure that all individuals.are treated equally and that no person shall, on the basis of ethnic group identification, race, color, national origin, political affiliation or belief, religion, sex, age or disability be excluded from participation in,denied the benefits of any program or service, or otherwise be subjected to treatment that is different than that provided to others. Each local child support agency has a designated Civil Rights Coordinator. Any applicant/recipient who feels they have been subjected to discriminatory treatment may file a complaint of discrimination by first contacting the local child support agency's designated Civil Rights Coordinator or by writing to the California Department of Child Support Services, Attn: Human Services Section, Civil Rights Office, P.O. Box 419064, Rancho Cordova, CA 95741-9064 or telephone (916) 464-5200. :S 196 (01/02) - CHILD SUPPORT SERVICES PROGRAM NOTICE- Pg 3 2404/MAY 05 Blank Page STATE O�: CALIFORNIA HEALTH AND HUMAN SEFVICES AGENCY DEPARTMEF47 OF CHILD SUPPOR7 SERVICES. NONASSISTANCE APPLICATION FOR CHILD SUPPORT SERVICES D=SS 0373(05;26!04) 1 AM THE: F—] CUSTODIAL PARTY F_� NONCUSTODIAL.PARENT APPLICANT NAME(PERSON COMPLETING THIS FORM( NOTE: The custodial party is the person or party who has primary custody of the minor children. FACTS ABOUT CUSTODIAL PARTY OR GUARDIAN AND CHILD(REN) FULL NAME(LAST, FIRST, MIDDLE) TELEPHONE NUMBERS BEST TIME TO BE REACHED HOME: HP.M. MAIDEN NAME 1!F APPROPRIATE) RELATIONSHIP TO CHILD(REN) WORK: - BEST NUMBER TO BE FATHER ❑MOTHER CELL: REACHED AT NAME OF CURRENT SPOUSE Lj OTHER ISPECIFY) OTHER(SPECIFY) [—)HOME ❑CELL ❑WORK ❑OTHER ADDRESS (STREET, CITY, STATE AND ZIP CODE) E-MAIL ADDRESS Does the custodial party currently live with the noncustodial parent? [DYES ONO (If "NO",give date and address last lived together) DATE ADDRESS (STREET, CITY, STATE AND ZIP CODE) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER STATE BIRTHDATE OR PLACE OF BIRTH RACE PRIMARY LANGUAGE GENDER: APPROXIMATE AGE SPOKEN IN HOME ❑FEMALE ❑MALE NAME OF PRESENT EMPLOYER- IF NOT CURRENTLY WORKING, PRINT JOB TITLE OR OCCUPATION GROSS MONTHLY EARNINGS "UNEMPLOYED" HERE $ ADDRESS OF PRESENT EMPLOYER (STREET, CITY, STATE, AND ZIP CODE) IS HEALTH INSURANCE AVAILABLE NAME AND TELEPHONE NUMBER OF A FOR CHILDREN? RELATIVE OR FRIEND DYES ONO Date and place of marriage (If never married, check "None") Date and place of divorce (If no divorce, check "None") DATE OF MARRIAGE TO COUNTY STATE ❑NONE DATE OF DIVORCE COUNTY STATE ❑NONE NONCUSTODIAL PARENT If parents were NOT married, please answer questions 1-5 below. 1. Has noncustodial parent ever lived in California? . . . . . . . . . [DYES ONO If "YES", When? Where? 2. Has noncustodial parent ever worked in California?. . . . . . . . . DYES ONO If "YES", When? Where? 3. In which state were the children) conceived? (Use number for each child listed below). . . . . . . . . . . . . . . . .Child # State Child # State Child # State 4. Was a Declaration of Paternity signed at a California hospital or agency?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYES ONO ❑DON'T KNOW If "YES", Where? 5. Was a Paternity Judgment established?. . . . . ... . . . . . . . . . DYES ONO ❑DON'T KNOW If "YES", Where? Have services been provided by another child support agency? (lf"YES", please give the date, city and state/ DATES OF SERVICES CITY AND STATE WHERE SERVICES RECEIVED HAVE THE MINOR CHILDREN RECEIVED CASH AID. (WELFARE) From: To: DYES ONO Is the noncustodial parent court ordered to pay child support for the child(ren) named below? DYES [--)NO ❑PENDING COURT ORDER x AMOUNT OF ORDER OPER WEEK DATE OF ORDER COUNTY STATE $ ❑PER MONTH List full names of all minor children by this noncustodial parent Of child is not yet bom, write "unbom", and expected date of birth). (A separate application is required for children from another noncustodial parent) IF CHILD IS NOT YET BORN, WRITE"UNBORN" HERE EXPECTED DATE OF BIRTH FOR UNBORN CHILD(REN) NAME SEX BIRTHDATE BIRTHPLACE (CITY AND STATE) SOCIAL SECURITY CHILD(REN) LIVING WITH YOU NUMBER 1• ❑YES ❑ NO 2• ❑ YES ❑ NO 3. ❑YES ❑ NO 4. ❑YES ❑ NO List full names of other minor child(ren) NOT related to this noncustodial parent NAME BIRTHDATE CHILD(REN)LIVING WITH YOU ❑YES ❑ NO ❑YES ❑ NO COMMENTS (Please attach a separate sheet if you need additional space) lc% State of California - Health and Human Services Agency Department of Child Suppon Services REQUEST FOR SUPPORT SERVICES INSTRUCTIONS: Read carefully before signing each of the areas below. Your signature is required in order for us to open a case for you. I request the services of the-local child support agency.to assist in my efforts to locate the noncustodial parent, establish paternity and/or secure support for the children listed in Section II. I am applying for these services under the Child Support Enforcement Program under Title IV-D of the Social Security Act. I will notify the Local Child Support Agency immediately of any of the following events: When each child marries, reaches age 19 or reaches age 18 and is not a full-time student, whichever occurs first. Any change in my residence address, mailing address, or telephone number. Any change in my employer, including name, address and telephone number. - Any change in my income. - Any change in the status, cost or availability of health insurance coverage. Any information regarding the whereabouts of the other parent(s). - When the parent(s) move back in together with the children. - Any change in the custody of the children. - Any change in child care. / am aware that the local child support agency and the Attorney General do not represent me, the other parent, or the children who are the subject of this case. No attorney-client relationship exists between the local child'support agency or the Attorney General, and myself, the other parent, or the children. No attorney-client relationship will arise if the local child support agency or-the Attorney General provides the support services l have requested. I declare under penalty of perjury that I have read, understand and agree to all of the terms specified above. SIGNATURE: DATE: Your signature below acknowledges that you are aware that any amounts overpaid to you may not be deducted from future support payments sent to you unless you consent in writing at the time, which consent may be revoked at any time. However if you do not consent to repay the overpayment to the county by a deduction from future support, the local child support agency is authorized to use the collection of the last unassigned arrearage payment to repay the overpayment. SIGNATURE: DATE: CSS 2115 (02/02) 7)40AINAAY nF i rcn r,�o ni State of California - Health and Human Services Agency Department of Child Support Services HEALTH INSURANCE INFORMATION Page 1 of 2 FULI NAME lFnsr, Middle.Last, Sufiiil DCUSTODIAL PARTY EJNONCUSTODIAL PARENT SECTION I: YOUR INSURANCE Complete this section if your insurance is provided or available through your employer or a private policy maintained by you and not the other parent. Section II is about the insurance provided by the other'parent. HEALTH INSURANCE Do you currently have Health Insurance coverage? ❑YES El NO If YES, complete the following information. HEALTH INSURANCE COMPANY INSURANCE COMPANY'S ADDRESS'. Street.Apt.or Unit No. to ddress where claims are mailed] City. Stare.Zip Code POLICY NO. PREMIUM DEDUCTION AMOUNT CHECK ONE: ❑ WEEKLY ❑BI-WEEKLY ED SEMI-MONTHLY MONTHLY AMOUNT PAID BY EMPLOYER AMOUNT PAID BY YOU CHECK ONE: ❑ WEEKLY ❑BI-WEEKLY ❑ SEMI-MONTHLY MONTHLY NAME(S)OF DEPENDENTS CURRENTLY COVERED BY HEALTH INSURANCE DEPENDENT'S POLICY NO. t, 2. 3. 4. 5. 6. .. . 7. 8. E] Check here if names&policy numbers of additional dependents covered by Health Insurance are listed on a separate sheet attached. DENTAL INSURANCE Do you currently have Dental Insurance coverage? ❑YES ❑NO If YES, complete the followinq information. DENTAL INSURANCE COMPANY INSURANCE COMPANY'S ADDRESS: Street.Apt. or Unit No. (Address where claims are mailed! City,State,Zip Code POLICY NO. PREMIUM DEDUCTION AMOUNT AMOUNT PAID BY EMPLOYER CHECK ONE: a WEEKLY D BIWEEKLY El SEMI-MONTHLY ElMONTHLY . AMOUNT PAID BY YOU CHECK.ONE. El WEEKLY El BI-WEEKLY SEMI-MONTHLY ED MONTHLY NAME(SI OF DEPENDENTS CURRENTLY COVERED BY DENTAL INSURANCE DEPENDENT'S POLICY NO. 4. 6. 7. E. ElCheck here if names &policy numbers of additional dependents covered by Dental Insurance are listed on a separate sheet attache.- CSS 21 1 1 (09/01/01) 24014/MAY n� State of California - Health and Human Services Agency Department of Child Support Services CHILD CARE VERIFICATION APPLICANT NAME: I am the ❑ Custodial Party ❑ Noncustodial Parent APPLICANT: Give your child care provider this form to complete. Attach any receipts or copies of canceled checks for child care that you may have. CHILD CARE PROVIDER: Complete the appropriate section(s) for the children. of the above named applicant for whom you provide child care. SECTION I: INFANT & PRE-SCHOOL CHILDREN Name of Provider/Day Care Center Address Apt. or Unit No. City State Zip Phone I ) Name of Person or persons who pay(s) you for childcare Name of the children of this parent for whom you provide care and the amount you receive. (Circle One) Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Total: S per week/month/day I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (Signature of Child Care Provider) SECTION II: SCHOOL-AGE CHILDREN A. For child care provided during regular school sessions: Name of Provider/Day Care Center Address Apt. or Unit No. City State Zip Phone Name of Person or persons who pay(s) you for childcare Name of the children of this parent for whom you provide care and the amount you receive. (Circle One) Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Total: $ per week/month/day I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (Signature of Child Care Provider) CONTINUED ON REVERSE I 1 CSS 2105 (09101/01) 21104/MAY 05 LCSA CASE NO.: State of California - Health and Human Services Agency Department of Child Suppor, Services VISITATION VERIFICATION NAME OF PERSON COMPLETING FORM: I am the ❑ Custodial Party ❑ Noncustodial Parent Part 1. ACTUAL VISITATION BY THE NONCUSTODIAL PARENT INSTRUCTIONS: Complete the visitation history for the past 12 months by filling in the number of hours per month the noncustodial parent actually visited with the children. Example: If the last 12 months are June of 2000 through May of 2001, you will complete June through December on the left side of the chart below. You would put 2000 for the year. Then you would complete the right side of the chart with January through May and enter .2001 for the year. YEAR YEAR NO. OF HOURS NO. OF HOURS MONTH PER MONTH MONTH PER MONTH January January February February March March , April April May May June June July July August August September September October October November November December December TOTAL TOTAL Part 2. SHARED CUSTODYNISITATION ARRANGEMENTS CHECK ONE: ❑ Shared Custody ❑ Visitation Only ❑ None Please describe custody/visitation arrangements: (Circle One) Visitation Hours: From (specify day of the week) at (specify time) a.m./p.m. (Circle One) To (specify day of the week) at (specify time) a.m.(p.m. Overnight Visitation? ❑Yes ❑No Is this custody/visitation arrangement court-ordered? ❑Yes ❑ No I declare to the best of my knowledge and belief that the above information is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation. Signature: Date: CSS 2107 1n9/01 i01) LCSA CASE NO.: 24n4/MAY n= CHILD SUPPORT DOMESTIC VIOLENCE NOTICE Date: AUGUST 12, 2005 Due to recent changes in federal and state law, the child support program must send child support computer records to the federal government. The federal government, will give the information to the courts, child support agencies, and sometimes to the other parent of your child. If you or your child is a victim of domestic violence, we will tell the federal government and they will not give out your information without a court. order. If you think that giving out your information may cause physical or emotional harm to you or your child(ren), fill out the enclosed form and return it to our office immediately. You must fill out the form completely, especially Section II. If you do not return this form to us in 30 days from the date of this letter, we will give your case information to the federal government for release to authorized persons and/or agencies. Mail the completed form to: OR Drop by our office at: DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE, SUITE 100 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ, CA 94553 MARTINEZ, CA 94553 If you or your child(ren) are not the victim of domestic violence you do not have to return this form. Please understand that your personal information is never given to the other party without a court order. The only exception is the filing of records or documents with the court in connection with certain court proceedings. If you have questions, the number to call is (925) 957-7300 Please have your social security number ready. DEPARTMENT OF CHILD SUPPORT SERVICES Office Use Only DATE FVI PLACED: DATE RECEIVED BY THIS OFFICE PLEASE COMPLETE FORM ON REVERSE SIDE CSS 2140 (09/01/01) • "CVR&I 2404/MAY 05 FL-150 A t i ORNEY OR PARTY W17HOU7 ATTORNEY/Name.State Bar number,and address): 00000055 FOR COURT USE ONLY 07DMr- ,v TELEPHONE NO.: E-MAIL ADDRESS 10prionall: ATTORNEY FOR IName): SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA STREET ADDRESS:751 PINE STREET MAILING ADDRESS:P.O. BOX 911 CITY AND ZIP CODE:MARTINEZ, CA 94553 BRANCH NAME:CONTRA COSTA SUPERIOR COURT PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: INCOME AND EXPENSE DECLARATION CASE NUMBER: 1. Employment (Give information on your current job or, if you're unemployed, your most recent job.) a. Employer: Attach copies b. Employer's address: of your pay c. Employer's phone number: stubs for last d. Occupation: two months here (black e. Date job started: out social f. If unemployed, date job ended: security g. I work about hours per week. numbers). h. I get paid $ gross (before taxes) per.month =per week 0 per hour. If you have more than one job, attach an 8112-by-1 l-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1 - Other Jobs" at the top.) 2. Age and education a. My age is (specify): b. I have completed high school or the equivalent: 0 Yes No If no, highest grade completed (specify): C. Number of years of college completed (specify): Q Degree(s) obtained (specify): d: Number of years of graduate school completed (specify): Degree(s) obtained (specify): e. I have: 0 professional/occupational license(s) (specify): 0 vocational training (specify): 3. Tax information a. 0 I last filed taxes for tax year (specify year): b. My tax filing status is: = single = head of household married, filing separately Q married, filing.jointly with (specify name): c. I file state tax returns in = California other (specify state): d. I claim the following number of exemptions (including myself) on my taxes (specify): 4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain): (If you need more space to answer any questions on this form, attach an 81/2-by-1l-inch sheet of paper and write the question number before your answer.) 5. Number of pages attached: I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) Page 1 of 4 Form Adopted for Manda[ory use FamINCOME AND EXPENSE DECLARATION 2100-x2113.3552. 36203634, Judicial Council of California FL-150[Rev.January 1.20051 4050-4076.4300-4339 www.courlinio,ca.gov t Z '7dlld/A/Ib V 1"1r PETITIONER/PLAINTIFF: CASE NUMBER: RESPDNDENT/DEFENDANT: L OTHER PARENT/CLAIMANT: 12. The following people live with me: How is the person That person's gross Pays some of the Name Age related to me? (ex:son) monthly income household expenses? a. 0 Yes No b. L]Yes �] No C. Yes No d. Yes No e. [�Yes No 13. Average monthly expenses: Estimated expenses Actual expenses Proposed needs a. Home: h. Laundry and cleaning ........................... $ (1) = Rent or = mortgage ............ $ If mortgage: i. Clothes .............................................. $ (a) average principal ....$ (b) average interest .....$ j. Education ............................................. $ (2) Real property taxes ............................ $ k. Entertainment, gifts, and vacation $ (3) Homeowner's or renter's insurance (if not included above) ............:........... $ I. Auto expenses and transportation (insurance, gas, repairs, bus, etc.) $ m.Insurance (life, accident, etc.;do not (4) Maintenance and repair ..................... $ include auto, home, or health insurance)... $ b. Health-care costs not paid by insurance ................................ $ n. Savings and investments ..:..................... $ c. Child care ........................................... S o. Charitable contributions ................ Monthly payments listed in item 14 d. Groceries and household supplies ........... $ p. /itemize below in 14 and insert total here) $ e. Eating out ........................................... $ q. Other (specify): ......................... f. Utilities (gas, electric, water, trash) ........ $ r, TOTAL EXPENSES (a-q) (do not add in $ the amounts in a(1)fa)and (b)) g. .Telephone, cell phone, and e-mail............ .$ s. Amount of expenses paid by others.......... $ 14. Installment payments and debts not listed above Paid to For Amount Balance Date of last a merit S S " S S S $ S $ 15. This form does [� does not contain the locations of,.or identifying information about, the assets and debts listed. NOTE: If the form does contain such information, you may ask the court to seal this document by completing and submitting an Ex Parte Application and Order to Seal Financial Forms (form FL-316). 16. Attorney fees (This is required if either party is requesting attorney fees./: $ a. To date I have paid my attorney this amount for fees and costs (specify): $ b. The source of this money was (specify): c. I still owe the following fees and costs to my attorney (specify total owed): $ d. My attorney's hourly rate is (specify): $ I confirm this fee arrangement. Date: ' (TYPE OR PFINT (DAME OF A-' DRNEY; (SIGNATURE DF ATTDRNEV, FL.150/Rev.January i.20051 INCOME AND EXPENSE DECLARATION Page 3 o,4 7A nn rnnnv nr= CHILD SUPPORT A UTOMA TED INFORMA TION _ LINDA D{PPEL SYSTEM DIRECTOR CONTRA COSTA The Child Support Automated Information DEPARTMENT OF CHILD SUPPORT SERVICES System allows you to use a touch tone phone to answer your child support _ questions. You can use the system to answer common questions and get information about your case such as: payment history, case balances, case _ status and enforcement actions. The system will also provide general office information such as: office location, mailing address, phone and fax numbers, office hours and services provided. The Child Support Automated Information System can be used by either parent, other custodial parties or agencies. You can use CHILD SUPPORT the system 24 hours a day, seven days a AUTOMA TED week to find out information on your case. INFORMATION SYSTEM The Child Support Automated Information System will allow the local child support DIAL 1-866-244-5382 agency to serve rnore people and provide faster service to the public. To use the Child Support Automated Information System, you must use a touch tone phone. The system will greet you with a menu of available choices. Simply listen and select the menu option you want by DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE,.SUITE 100 pressing the correct button on your phone. MARTINEZ, CA 94553 You must have your social security number and participant number to access case level information. For the best results, review the information provided here and keep it handy. N r q 1 161 Case k DEPARTMENT OFCHILD SUPPORT SERVICES FACT SHEET CHILD SUPPORT STATE HEARING PROCESS You Have A Right To A State Hearing • If the local child support agency does not..respond to you within 30 days after receiving your complaint, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for a State Hearing must be made within 90 days after you complained to the local child support agency. • If the local child support agency does respond to you within 30 days after receiving your complaint, and you are not satisfied with the local child support agency's complaint resolution or response, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for a State Hearing must be made within 90 days after you received the local child support agency's written response to your complaint. • You can request a State Hearing in writing by sending a Request for State Hearing (form SHOW) to the State Hearing Office, or you can call the State Hearing Office at 1 (866) 289-4714. • The State Hearing Office will let you know the date, time and place of your State Hearing and will provide an interpreter or disability accommodation for you at the hearing if you need one. IMPORTANT: Not all complaints can be heard at a State Hearing. State Hearings will only be granted for the following issues: • An application for child support has been denied or has not been acted upon within the required time frame. • The child support services case has been acted upon.in violation of federal or state law or regulation, or Department of Child Support Services policy letter, including services for the establishment, modification, and enforcement of child support orders and child support accountings. • Child support collections have not been distributed, or have been distributed or disbursed incorrectly, or the amount of child support arrears, as calculated by the local child support agency is inaccurate. • The local child support agency's decision to close a child support case. IMPORTANT: The following issues cannot be heard at a State Hearing: • Child support issues requiring a motion, order to show cause, or appeal in court. • A review of any court order for child support or child support arrears. • A court order or equivalent determination of paternity. • A court order for spousal support. • Child custody or visitation determinations • Complaints of alleged discourteous treatment by a local child support agency employee, unless such conduct resulted in a hearable action or inaction. HELPING TO MAKE IT EASIER FOR YOU Department of Child Support Services Toll-free Telephone Number 1 (866) 249-0773 17,1101 (VIII':VIIIVIII VIII ILII 1111111111 III!!11,1111 Wil M1 119111911111111111111111 oil el • Sta•ce of California - Health and Human Services Agency Department ui Child Support Services INSTRUCTIONS FOR COMPLETING THE DECLARATION OF SUPPORT PAYMENT HISTORY The reverse of this page is your declaration of the support payment history for your case. You are asked to complete a month-by-month, year-by-year breakdown of the amounts of support that were due (ordered by the court) and the amount of each payment that was made. These figures will help determine the amount. of past due support owed, if any. You must complete a separate page (or pages) for child-support, spousal support, family support, 'medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order. In the Amount Ordered column, fill in the amount of support that became due each month since your court order began. If there has been a change in your court order, make sure each month reflects the correct amount of support due. In. the Amount Paid column, indicate a dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amounts next to the month in which the payment was actually made, and not the month or months which those payments were intended to cover. You may attach additional sheets as necessary. Be aware that this declaration is not confidential and may be given to the other parent in your case for review. if there is a disagreement regarding the payment history, the parties may be required to present proof of payments in the form of canceled checks, receipts, etc. Complete this Declaration neatly and correctly to make sure there is.no mistake nor confusion as to. the amounts of past due support owed, if any. CSS 2109 (09!01/01) LCSA CASE NO.: 25351 Serving _ California CONTRACTORS STATE LICENSE BOARD --�— • 9821 Business Park Drive,Sacramento,California 95827 STATE OF CALIFORNIA Mailing Address:P.O. Box 26000,Sacramento,CA 95826 Arnold Schwarzenegger,Governor • 800-321-CSLB (2752) www.cslb.ca.gov 150-DAY NOTICE OF INTENT TO SUSPEND SSN: 556-37-5698 TO: M AND M GENERAL CONTRACTOR DATE: 02/10/2006 2981 SADDLE DR OAKLEY, CA 94561 LICENSE: 707771 BUSINESS TYPE: SOLE OWNERSHIP Dear MICHAEL JACK DAMS. The following.District Attorney(s) has identified you as a person who is out of compliance with a child or family support judgment or order: CONTRA COSTA COUNTY LCSA DISTRICT ATTORNEY'S OFFICE CONTRA COSTA COUNTY 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ CA 94553-0 Pursuant to the Family Code section 17520, effective 07/11/2006, your license will be suspended unless a release is received from the District Attorney(s) listed above. Fees already paid cannot be refunded. This suspension may not be appealed to the State (Board or Bureau). Any license suspended under this section will continue in this status until the expiration of the remaining license term, unless a release has been received from the District Attorney(s) listed above before the license expires. If you do not agree with the action to suspend your license, you should fill out the enclosed form "Notice of Request for Review", and mail it to the District Attorney(s) listed above. When the Department of Consumer Affairs receives the release from the appropriate District Attorney(s), your license will be reinstated for the remaining license term. ANY QUESTIONS SHOULD BE DIRECTED TO THE DISTRICT ATTORNEY(S) LISTED ABOVE. 1 II11NI I N III IIII 111111 N NIIiI INiI IINI IIN II Ililll N IIIN�I IIS N I� *T-Fq-1 gin_.qTTgp* IIIINI�INIIIIIIIIII����INIII� .�T �. . ,r T<I L OF CA.IFORMA-HEALTH AND HUMAN SERVICES AGENCY DEPAF T MEN-, DF i;HII.D SUPP,-,RT SER'ViCES MONTHLY BILLING STATEMENT DOSS-265(1229/06) LCSA CONTRA COSTA STAT MENT DATE 04/01/2008 PARTICIPANT ID NUMBER: 0070000052811 MICHAEL DAVIS PARTICIPANTNANIE: MICHAEL DAVIS 2981 SADDLE DR OAKLEY CA 94561-1730 SUMMARY OF AMOUNTS OWED CASE AND COURT ORDER CURRENT AND PAST DUE PAYMENT INFORMATION ARREARS INFORMATION INFORMATION = MONTHLY MONTHLY TOTAL MONTHLY TOTAL CASE PAYMENT PAYMENT PAYMENT PAYMENT DUE INTEREST PRINCIPAL INTEREST NUMBER FOR CURRENT AND BALANCE BALANCE AND FREQUENCY DUE FOR DUE FOR AND AMOUNT CURRENT PAST DUE PAST DUE SUPPORT PRINCIPAL SUPPORT SUPPORT BALANCE 0070027139-01 MONTHLY 1 50.00 50.00 500117 18611 00 23612.17 TOTALS. I 000 50.00 50.00 5001.17 18611.00 23612.17 * If there is an arrears balance and there is no court.order for monthly payments toward arrears, arrears continue to be due and payable, unless and until you are notified otherwise. • Interest on past due support accrues of the legal rate. • This balance may not reflect all interest or other charges you may ow-0. • Support that has accrued and payments posted after the statement ending date will be reflected on your next statement. COMMENTS/SPECIAL INSTRUCTIONS: If you feel this information is not correct, please contact us at (866)901-3212 or the-address provided on the Notice Regarding Monthly Billing Statement attached(DCSS 0274). Please tear off payment coupon below and return it with your payment to ensure proper credit to your account. a PAYMENT COUPON NOTE: If the total minimum payment due is automatically being deducted from your pay, you do not need to send in any additional payment. PARTICIPANT NAME MICHAEL DAVIS ENTER AMOUNT OF REMITTANCE: PARTICIPANT ID NUMBER 0070000052811 Please make checks payable to. CALIFORNIA STATE DISBURSEMENT UNIT CALIFORNIA STATE DISBURSEMENT UNIT Please write your participant ID number PO BOX 989067 WEST SACRAMENTO CA on your check. 95798-9067 IIIIIIIIIIIIIIIIIIIIIIIfIIIIIIIIIIIIIIIIIIIIII;11IfIII IIIIIIII (Ws I ;ATE uF;:ACIP ORNIA IIEAI.iI.!AND I HUMAN SERVICLS Ai�L fl�l' ULNAR I ML-IJ I OF(;I-!!LU:;1.jPP6R1 SEF'J!�ES MONTHLY BILLING STATEMENT.- DETAIL TATEMENT -DETAIL BY CASE NUMBER DC S S:I[75 j0d'16/G4) PARTICIPANT NAME: MICHAEL DAVIS SWEMENT BEGINNING DATE: 03/01/2008 PARTICIPANT ID NUMBER: 0070000052811 STATEMENT ENDING DATE 03/31/2008 PAYMENTS RECEIVED AND OTHER ADJUSTMENTS APPLIED TO: CASE INTEREST O NUMBER DATE DESCRIPTION AMOUNT CURRENT PAST DUEPAST DUE SUSUPPORT PPORT 0070027139-01 03-31-2008 INTEREST CHARGE 157.63 0.00 157.63 0.00 • Interest on past due support accrues at the legal rate. • This balance may not reflect all interest or other charges you may owe. • Support that has accrued and payments posted after the statement ending date will be reflected on your next statement. ,,)-I51 �J From: tilden@moschettilaw.com To: michaelaaron@live.com . Subject: RE: Davis case Date: Wed, 5 Mar 2008 15:29:28 -0800 I am working on it. It would help to talk to DCSS first, which is what I am trying to do. M. Tilden Moschetti, Esq. 633 Battery Street, Suite 640 San Francisco, CA 94.111 Ph: (415) 399-0970 Email: From: michael davis [mailto:michaelaaron@live.com) Sent: Wednesday, March 05, 2008 3:21 PM To: tilden@moschettilaw.com Subject: Davis case Tilden, I was wondering if you got that case filed or dismissed yet,you told me it would ne no problem, Thankyou Michael davis Connect and share in new ways with Windows Live. Climb to the top of the charts! Play the word scramble challenge with star power. I received a letter from Child Support today april 19,2008 and I talked to a visitor at my parents house who is retired from Law enforcement after 30 years of service and I was told that it was fraud what my son's Mother Elizabeth Hoy did to get child support accessed against me, I thought it would be in my best interest to make a police report especially since Elizabeth Hoy has collected up to a couple thousand from Tina Davis and just lately Elizabeth Hoy had approk. $300 taken from my taxes for what has been described as fraudulent child support claim by Elizabeth Hoy'at one time she even contacted my mother about the checks.I am afraid this county will now try to arrest me for non payment of child support.These are the officers name and incident report. Michael Davis "LN` �$ CL��►ID��s � RHENELLE DANIF.LS Polio(fn•r Grnr o/ OAKLEY 32:11 ,lain Sirect Oaldcc.CA 9.1.561 925 625 8855 0Ilicc !.I&Fit.KI./t&DI:1:r,% 925 625 8837 VIII 925 625 8060 dispatch �0 O 1 L.. 425 625 8857 fis Y.A2-I,E2iE BECSING, Ph.D. % Licensed Psychologist PSY4550 v� 47 Quail Court , Suite 212 Walnut Creek, CA 94596 (5 10 930-7664 ?SYC:IOLOGIC=.L EVAL'uA.T_CN Parents : Elizabeth Morris Bi=t Date_: Michael Jack Davis Birth Date: 9/2/67 Child: Michael Davis , Jr. Birth Date: 12/7/92 Case No . 93-00892 Date Report Prepared: 4/30/94 REFERRr_y Parents underwent court-ordered psychological evaluation in order to assist the court in the upcoming May 31 , 1994 custody hearinc. TESTS ADMINISTERED Rorschach Minnesota Multiphasic Perscnality Inventory - 2 (MMPI-2 ) Parenting Stress Index (PSI) Thematic Apperception Test (TAT) Individual Dates Time Contact Michael Davis 1/24/94 2 hrs_ Interview t . . t Michael Davis 1/31/94. 1-1/2 hrs. Interview Michael Davis 2/07/94 2 hrs_ Interview Michael Davis 2/21/94 1-1/2 hrs. Rorschach, TAT , MMPI Michael Davis 4/25/94 PSI; Sentence Completion Elizabeth Morris 4/01/94 2-3/4 hrs. Interview, Rorschach Elizabeth Morris 4/15/94 3-1/4 hrs. Interview, TAT, ML MPI Elizabeth Morris 4/25/94 1 hr. MMPI, PSI, Interview Mickie with father 1/4/94 1 hr. Family Observation Mickie (child) 4/25/94 1/2 hr. Play Observation Mickie , mother and Tom (bcviz=end) 4/25/94 i hr. Family Observation jr.ic ' hdel Davis , Psl�no'logical Evaluation Page-Two 4/30/94 In addition to the above 16=1/.2 face-to-face clinical hours , I also reviewed the following documents : Complaint to Establish Parental Relationship and Requested for Order for Child Custody and Visitation (2/26/93 ; 6/17/93 ; 10/5/93) Declaration of Elizabeth Morris (6/16/93 ; 6/16/93 ; 6/29/93 ; 10/5/93 ; 10/5/93 ) Declaration of Judy Morris ( 6/16/93 and 6/29/93 ) Declaration of Kenneth Morris ( 6/16/93) Memorandum of Understanding in Mediation Proceedings (6/18/93 ) Michael Davis ' s Letter (undated) to maternal grandparents Elizabeth Morris ' s Letters (undated) to Michael Davis 6 pictures of Elizabeth Morris after 5/9/93 Assault by Michael Davis Picture (6) of burn injuries of Michael Davis, Jr. (8/7/93) Delta Memorial Hospital EM Report (8/7/93) by Dermontt, R.N. ; Judie Whitehall , M. D. and (8/8/93) by R. Virgel, M. D. Antioch Police Report (8/7/93 ) by Officer R. Fromme Suspected Child Abuse Report (8/9/93) by G. Zimmerman, M. D. Social Service Authorization for Temporary Custody-Kathleen Carrier (8/8/93) Contra Costa County Social Service Log of Contacts (8/9/93-8/12/93) J. Kaplan, M. D. of Burn Center - Alta Bates Report (8/10/93 ) John Copeland, M. D. Letter (8/20/93) of 8/9/93 exam Declaration (8/23/93 ; 8/27/93) by Elizabeth Morris "Delta Memorial Hospital and Risk Doctor Lawyers and Judge Conspire to Steal Baby for Crazy Acting Risk Doctor ' s Son" poster Elizabeth Morris Lawsuit (116945) vs Delta Memorial Hospital, etc. (9/16/93) alleging malpractice, conspiracy, fraud, breach of duty, libel and slander, negligence, intentional infliction of emotional distress , breach of court orders Elizabeth Morris ' s threatening letter (9/20/93) to Pete Wilson, Judge Josanna Berkow, and Contra Costa County DA Newspaper (9/4/81) clippings of marijuana raid on maternal grandparents Preliminary Hearing filed 12/11/81 on maternal grandparents charged of cultivating marijuana Kenneth and Judith Morris Declarations (1/14/85) of fire of 10/9/84 Kenneth and Judith Morris (27143 ) Opposition to Notice of Hearing on Demurrer to Complaint and Notice of Impeachment Proceedings of Judges (12/4/85) Kenneth and Judith Morris Complaint (27865) for Personal Injury (7/1/86) and Amended Complaint: Rape of an American Family, Fraud and Deceit, Libel , Slander, Invasion of Privacy, Defamation , Oppression, Malice Michael D4 S , Jr. Psyci7ological Evaluation Page ' Three 4./30/94 Cour` Order ( 27239 ) to Compel P'_aintiff (Kenneth George Morris) to Furnish Security and For Stay of Proceedings ( 1/20/89) , findincr maternal grandfa—er as "vexations litigant" Letter of Commendations ( 11/4/92 ) for Mike Davis from supervisor Newspaper -articles (5/7 ; 5/0 ; 5/12 ; 5/15/93 ) on Dansville ' s investication of father ' s supervisor Memorandum (5/4/93 ) from City' Attorney to Town Manager regarding . investigations of . Chief Building Officer: Father ' s medical reports of Del-L-_ Memorial Hospital (1987-88 ) Alvin Turkin, M. D. Disability Report (1/10/94 ) Reported tape of conversation between Michael Davis and mother' s friend Kathy (Woody) John Muir History and Physical Report by Thomas Bell , M. D. on Michael Davis , Jr. (2/15/94 ) and Discharge Summary (2/18/94) Medical records on Michael Davis , Jr . (10/7 to 3/29/94) Deborah Levine, Esc. (2/16/94) Letter to Gregory Abel , Esa. In addition, I consulted. wit:i the following individuals: John Kencaid, Ph. D. father ' s therapist; John Hamel, father' s anger management therapist; Edith Rischer, Family Court Service, paternal grandmother, and Nancy Morris (zotherIs sister) . STATEMENT OF THE PROBLEM Psychological evaluation was re:.-uested because of the serious nature of the allegations. Mother presents father as a violent, "crazy" male who nearly killed her on previous occasions while endangering the child. Father, on the other hand, gets very agitated and reports going through "living hell" every time he has to come in contact with "those people" -- seeing them as tzying to destroy his son while "baiting" him to loss control so they can put him in jail and win custody. Father was recently (2/94) sentenced to 120 days in jail or work duty for his brutal assault of mother 5/9/93 . Yet suspicion also have been raised that mother is neglecting or abusing the child. August, 1993 , Michael 'was picked up from mother' s care with a suspicious burn; February, 1994 , father picked up Michael from mother in such a fragile physical state that he required immediate 3-day hospitalization with oxygen and 1V treatment. Illegal drug and alcohol allegations as well as . threats of lawsuits also complicates the picture_ Temporary custody of Michael was originally given to mother June, 1993 with father granted supervised visitation; August, 199" father was then granted physical custodv with mother granted supervised visitation; joint custodv was ter,Lorarl awarded to both parents _n December except for t:.o month ceriod from F ebrsary _c xav 'when M'LaInael Daviss s , Jr. Psychological Evaluati on Page Four 4/30/94 father had primary physical custody . Currently father has 'Xichael four nights (Monday 6 : 00 o. m. to Friday 4 : 00 p.m. ) with mother having Michael th e remaining three days . P_lthcuch transition occurs at the police station, incidents of unnecessary screaming apparently occurred between the parents, though somewhat decreasing in intensity lately. Mother sta-ces in her fantasy she does not see father as' involved in anyway with Michael because "I 'm afraid for him to be with that guy. " Father sometimes becomes tearful and remorseful over his assault of mother; yet other times , he goes "off the deep end" in -his accusations against mother, ostensively motivated by her intention to "protect" Michael . CURRENT CONCERNS Parents met November, 1991 and separated May, 1993 when Michael was 5 months old, after a violent encounter between each other. ,Mot -her earlier had moved down from Chico to reside with father and paternal grandparents when she became aware of her pregnancy; after about four months , the couple moved into their own studio apartment, but never married. This is both parents ' first child. Father has been married 1-2 times previously; mother has not yet married, although she considered herself currently engaged. Mother alleges she is "terrified" that father will still kill her as she states he has threatened and attempted to do on several previous occasions. She states the baby is not .safe with father because of his explosive temper, erratic behavior; and threatens to steal the baby. Mother believes he would hurt the baby to get back at her. She states father "was arrested for beating his ex-wife in Colorado and them skipped bail to California" ; that he has bragged to her that he "planted bombs in cars and even shot a man;" that he ")mows people who kill for money and has been involved with the Hells Angels and with big time drug dealers. ". Mother sta-Ees father has been a habitual crank, crack, and steroid user. She reports catching him shooting steroid at his parents ' house March, 1993 . Mother states father' s personality is so warped and his behavior so inconsolable that paternal grandparents had him institutionalized at a mental hospital, but he escaped before treatment. She states the past year, father has "broken any order of the tour-- and laughed about it behind the judge ' s back. " She is particularly unset at him for not returning possessions she believes he has taken from her. Michael i:;::1v4' s , jr. Psy�holoctical Evaluation Page Five 4/30/94 Materna' grandmother alleges fatter has repeatedly threatened to kill and hurt her. In addit;cn, she states paternal grandmct!Ier advised her to have their dauc sLer "moved cut of the state, c:iance her social szcurity_ number, ctange her name and disappear . I can ' control a deranged 32 year old man. We are afraid for cur lives . ,, Paternal grandfather alleges father has been "arrested on numerous occasions in different states for beating up women . . . was kicked out of high school for fic;Zting everyday is under investigation by his former employer, the City of Danville. " Based on father' s violent assault on mother May 9 , 1993 and his history, mother was granted physical custody of Mickie June 15 , . 1993 while father was given supervised visitation: Less than two months later, when father picked up Mickie for. his first overnight supervised visit, he noticed suspicious marks on Mickie . Father then tock Mickie to numerous doctors, three at Delta Memorial Hospital (Judi Whitehall , M. D. , initial ER visit 8/7/93 ; Rocer .Virael , M. D. 8/8/93 ; Gene Zimmerman, M. D. exam on 8/9/93 ) , John Copeland, M. D. (exam on 8/9/93 ) , and Jerald Kaplan, M. D. at Alta Bates Burn Center on 8/10/93) . The reports generally indicated the burn non Mickie ' s foot were suggestive of neglect, if not abuse, because of the shape and deepness of the injury was inconsistent . with mother' s account of the injury of a curling iron dropping on his foot; concerns were also raised by mother' s failure to obtain immediate medical treatment (8/3/93) for the injury or to communicate anything to father about the injury when he picked up the child from her. Mother alleges the doctors were "bought" by father and accuses father of "doctor shopping. " She then initiated a lawsuit (9/16/93 ) alleging malpractice, conspiracy, fraud, intentional inflection of emotional distress, breach of duty; etc. against Delta Memorial Hospital and the doctors associated there, father' s parents, the therapist and his attorney as well as Dr. Copeland and Alta Bates Medical Center. Four days later, mother threatened to add the Governor, Judge, and DA as defendants to this suit although she later withdrew the lawsuit. Paternal aunt had previously stated to CPS (8/9/93) that father was trying to get another evaluation "due to possible conflict at Delta" because of paternal grandfather' s 32 years employment at Delta Memorial- Hospital as an anesthesiologist-. When father told CPS (8/10/93 ) that he was going to go to Family Court for an immediate hearing to obtain custody, CPS decided they had "no basis to file" since there were "no allegations against father. " Chico. Police Department (8/17/93) subsequently found no evidence of criminal neglect by mother. Based on the allegations of abuse/neglect, father was given physical css`odv Auausu 20 , 1992 Michael ' :.1vis , Ji Psvchcl�:;tical Evaluation ,Page, Six 4/30/94 With mother granted supervised visitation. in December, 1993 , the temporary order forjoint custody was established as well as a,, attorney appointed to protect the interest of the child and help mediate between the couple. Somewhau later, an additional allegation arose that mother was neglecting 11ick_e because he has to be hospitalized a`tar being ticked from her care. Apparently 2- 3 weeks later Amoxicillin was prescribed for "tonsillitis ana a slightly red ear. " Dr. Sell noticed that when he examined Mickie 2/10/94 , that he was considered improved although he clinically demonstrated continuing sign of otis media so Dr. Bell changed the medication to Septra . In addition to concerns of Micki e 's safety, father raises issues that mother may be abusing drugs or alcohol , that she raise M.icki e to be a "loser" like her parents , and to develop poor morals by telling him to lie, to leach from the system or file false lawsuits for personal gains . He reports that maternal grandfather was found a "vexatious litigant (1/27/. 89) , that maternal grandmother was arrested (11/19/8.4 ) on charges of setting a fire to some of her possessions in order to buy new furniture for moving into their,new home; that maternal grandparents. attempted (12/85) to start impeachment proceeding against judges., and that maternal grandparents were charged 12/81 with cultivating marijuana in their backyard. He states that maternal grandmother perjured herself in court by stating 6/16/93 "The only drug I have ever taking are prescription drugs. " A friend of mother since 6th grade (Kathy Woody) has stated to father that she used to do drugs frequently with mother (e.g. coke) that maternal grandparents regularly bought drugs from her ex-boyfriend; and that she got "loaded" with mother as well as maternal grandmother. FATHER 'S HISTORY AND EVALUATION Father comes from an intact family with three sisters. His parents are currently retired with father prematurely forced to step down earlier than he had anticipated because of nine triple by-pass heart surgeries. He general describes his parents as religious, hard-working people_ He states his father did not have time for friends growing up and that he worked his way through school to become an anesthesiologist while taking care of his sibling. His .mother was a nurse. His mother worked full time while he was growing up and his father was working 12-15 hours a day. Father and grandmother repot n that although Mike had been an A and B student up to the 8th grade, they increasingly had difficulty with his adolescent rebellion. Father always felt, and grandmother confirmed, that he was not livine un to their expectations -- that Michael D - s Jr. �;= Psychologi&I Evaluation Page Seven 4/3.0/94 he was lectured from his father "You 're neve- going to be nct ling - Your life is wasted, " because his goal in life has been to be a baseball player instead of a professional which his parents wanted . At aged 14-15 , he smoked marijuana , stated that his auzitude went "to hell , " his grades drooped to D ' s. and i ' s , that he startad hanging around different sits (drug friends) , and dropping out athletic activities . His parents became concerned about -"-he situation, "tricked" him into getting admitted into a one wee, psyc:Ziatric evaluation at McCauley Clinic when he was 15 years old . After completion o.-L- the evaluation , father moved in with paternal aunt and uncle for a year. He responded well to his relatives "respect, " "limit and responsibility" ; his grades went back up to Bs ; he regularly helped out his relatives on the ranch, got a job and bought himself a car. - He then returned home to finish high school . At aged 19 , father was married for a year when the girl he was involved with became pregnant; although she had a miscarriage three weeks before the wedding, and father stated he wanted "out, " he went ahead because he . did not want to hurt the girl ' s feelings or disappoint his aunt and uncle. Father describes his relationship with his father- as improved as he has got older since he sees his father as more open-minded and better able to relate to him. Yet he still feels put down by father, even in areas he knows his parents feel proud of him (e.g. athletic abilities ; his parenting of Mickie where he has been told he "puts women to shame") ; father states a compliment from his dad goes something like "I didn' t think you could do it, but you' re better than I thought. " He also described father as someone who has had trouble handling pressure and that he frequently screams and flies off the handle at home while his mother works to keep peace. Father denies being a violent person, but sees his anger problem as caused by letting things build up inside until he explodes. He reports first getting into trouble with his anger when he was 17-18 and he beat un another kid for pushing his sister. He believes he was responding at that time to peer pressure - that he would be looked down. upon if he did not do something to protect his "little" sister. Charges were pressed at the time, he pleaded guilty, and he was put on probation for six months to a year. When he was 23 years old, father reports his driver 's license was suspended for a while because he had too many tickets (e.g. stop and go, speeding, etc. ) . During another perica in father' s life he described himself as having anger management problems. These occur-ed eight years ago when he was on steroids and he felt pumped -up with "steroid rage" and c:,-nstantl,7 on edge (e. g. he could not help tolerate standing in _cna :ine; He was 25 years old at the t_me when he became Lidvls , Jr. ' Psycholot".::. al Evaluation Page Eigf 4/30/-94 involved in a turbulent, abusive relationship with a 37 year old woman he alleges was on drugs . Police were involved on a couple of occasions when he allegedly beat up the woman and hiz a guy he states pulled out a gun on him. Father believes this woman told the . police one thing, yet something else to him. For instance he described her coming over to his house when she had a res training order against him, having sex and telling him she would drop the charges if he would marry her. He reportedly did to go to Las Vegas and got married although he says he filed for false information so he believes he is not legally married . The relationship reportedly lasted five months and he has not seen her since.. He believes he has put himself in a lot of bad relationship in the past. After getting out of this relationship, father reports trying to straighten up, get off the steroids, and go back to school to try to make something of himself. He met Liz while finishing school , then moved to Danville to accept a job as a building inspector. Father' s relationship with mother also reveals major anger control problems . At times father seems to be beginning to take responsibility for his assault. Thus he immediately went into therapy, attended anger management classes , and showed some remorse for what he did to mother. He feels in the long run "this might be the best thing that happened to me. " 'Yet, it still does not take much to provoke father, at least verbally, or put him in the state where "he is embarrassed about having associated with such low life people, " or overly agitated about the situation. Father attributes his assault on mother in part to the stress he was under at the time. In addition to mourning the loss of his uncle' s death, father was feeling a lot of stress in his employment as a building inspector for the City of Danville. He was doing a lot of overtime work (at times 130 hours every two week) and asked to do illegal things for his boss . Things started heating up when a new employer started to go to the DA with his boss. Father then felt "caught in the middle" as the DA interviewed him (first week of May, 1993 ) and he experienced the City Attorney and management trying to get him to cover up. When he testified against the City, he was told that week that his job wasover although his boss was subsequently indited and father received a settlement from the City of Danville. In any case, later that week Friday, May 7th, he felt exhausted and. fell asleep at the wheel, woke up when he taken by an ambulance to the hospital, after running into a tree. The following Sunday, on Mother' s Day, he assaulted mother and lost his son. A couple days later his father was hospitalized for another emergency surgery and he felt his life was torn anart. He sees his therapy as helping him put back the pieces. .incl L' Yls , Jr �'s cholo �1 Evaluation Page Nine'. 4/30/94 Father reccrts his drug history consists of smoking "pct" cne year when he was 14-15 years old. He states he tr=ed cocaine one time when he was 20-23 but he did not like it but then became addicted for about a year to steroids (under doctor supervision) wh-en he was 25 years -old. Father described himself as a very competitive man particularly in athletic activities . He denied ever selling drugs and being involved with the Hells Angels ; he apn_ ears to drink alcohol minimally. Father has been out on disability although he has started going back to work (against doctor I's recommendation because he cannot stand to stay at home "mauling over things," ) . He sees his energy as equally divided between his son and work, with little left over for social or dating ex-cerierces . He reportedly -broke off one relationship because the woman did not meet his parenting standards. He states he has always wanted children, volunteered time babysitting relatives ' children, served as a coach of little league teams, etc. or has donated time or money to children' s charity events . On interview and testing, father comes across as a highly intent but rigid, naive male who often seemed to lack social awareness of how he comes across. He is outgoing, enjoys social contacts , but is overly depended on others for feedback, directions , and affi=ations of his personal worth. At times there is a macho, competitive quality to him and he comes across as intolerant and crude. Although he shows some introspections, there are large gaps in his insight. He has a distorted notion of himself and others, and he can be defensive about acknowledging psychological problems. Although apparently bright enough, serious distortions and problems were seen in his thinking, judgment, and decision making-. On occasion, his emotions can take over, especially when dealing with his relationship with his father or authority issues. He then can get so agitated or flooded with rage to the point he has to work hard to maintain reality and control. Yet capacity for control was greater than I had anticipated from his history -- probably because of his therapy and anger management classes. Yet his behavior and thought process are still unduly influenced by his early emotional struggles and continuing need to reassure himself that he is adecruate_ He is overly invested in protecting his son, but does show a stronger capacity to connect to people than mother, a drive or ambition to better himself, and a capacity to become involved with therapy and make some changes. I did not see evidence of an .addictive personality or conduct disorder with -father even though father has demonstrated a history of some serous assaultive acts. • 1 , Michael Davis, Jr. ' Psychology`. al Evaluation Page Ten 4/3.0/94 MOTHER ` S HTSTOP.Y AVD EVALUATION Mother has an older 32 year old brot-ter from her mother ' s first marriage acid two siblings, a 14 year old brother and a 19 year old sister frcm mother ' s second. Her parents divorced when her mother _was three mcnth pregnant with her. Subsequently her mother did not want to have anything to do with her father so she never got to know him. Mother states her father was "never a part of my life, " because her stew-father was there. Mother reports that her mother has not been working in the past year and that her step-father is currently on disability for his back injury. He has been working the past three years as a used car salesman. After serving time in Vietnam step-father reportedly graduated from college with a decree in religion which he does not use. Sten-father also initiated a lot of lawsuits for himself and others as a paralegal . Although mother reports begin embarrassed scmetimes of his legal suits , she apparently relied on his help and support last September in filing heevery -one-lawsuit against everone she Perceived as supporting father' s position that Michael ' s burn looks like abuse or neglect. Although . mother states that she later dropped the lawsuit on advice of her family court attorney, she continued to feel justified in suing because she saw herself as . unfairly treated and "felt victimized ' by the system" because "it was like. somebody kidnapped my baby. " Aside from mother' s limited contact with her father and her older brother whom she described as a "rebel , " mother described her family as very close. Mother described her mother as one of her best friend, someone she calls one to two times a day, who. is a good parent for her because "she always tries to get me whatever I wanted" (e.g. a pony for her when she was 7, a horse when she was 12) . She was reportedly 14 when her parents were busted for marijuana and her parents lost their catering business. Mother reports money then became a problem for them, but she recalls little =emotional impact otherwise on her. she reports always getting good grades in school with little effort. After graduation from high school, it was hard for her to decide what to do. For ,a year she worked as a horse groomer at a ranch, then worked 2-1/2 years as a cashier, with last 3-1/2 years as a waitress. Mother states she has been on disability since last May when father beat her ' up. She. decided to go back to school with a goal now of becoming a teacher. She is taking classes on Tuesday and Thursday from 8 : 00 a.m. to 5 : 30 p.m. She anticipates continuing at this rate until she has her AA degree ==om Butt Cz-11ege in June, 1905, then intends to transfer to Chico State to complet_= her certificate. She w i' i' have tc cc back tc Ncr:•c in. June when her Michael C;; °;:his , Jr. Psychdlogical Evaluation Page Eleven 4/30/94 disability runs out or apply for a student lcan . She wants her teac.iine credential as soon as possible. Mother denies using any drugs except for marijuana about 9-_o times when' she was 15-16 years old. She states she has no resmect for people who spent time or money on drugs although she acknowledged her parents and friends use drugs regularly. She also denies having any alcchol problem although she acknowledged being arrested twice. for 3UI ; one arrest occurred in 1992 when she was "set up" by father and one time in 1988 . . She also acknowledged she was arrested when she was ! 8 years old for petty thief. Mother reports that she has always wanted to have a family with two kids, a nice house and to be "in love with a good man" and have lots of animals around. Her stated philosophy of dZild rearing is "fun is important - to keep a happy outlook. Education is important; as a kid I like to read. It is impertant to use your imagination. It is important to have social ties , like cub scout; to be involved with church. " Currently mother is residing in a two bedroom apar-tment in a government subsidized housing unit with her 19 vear old sister and Lr boyfriend Tom. Mother reports that Mickie sleeps in their bedroom in his ow-n crib. She reports that her and Tom have been together seven months and described their relationship as one that she has always dreamed about, but no recognition that she has previously described her relationship with father in a similar way. Mother states that she intents to be married by June, 1995 to Tom. Mother reports having lots of concerns about Mickie now. She states he has been sick and on antibiotic all winter whereas he was never sick when he was with her. Although she states that father "was fine with the baby when we were together, " she now raises suspicions he is teaching Mickie to "beat up others. " She noted when she dropped him off one time at Day Care, he went up to another child and grabbed and bit him. She believes Mickie throws his - food and laughs because father, is teaching him to do these things. However, in my family observation sessions, mother was noted to frequently sit back passively when Mickie threw tinker toys around the office or smile at him while verbally telling him. to stop without making any physical intervent-'Lon. Fattier was noted to be more effective about intervening with siting limits around throwing things. Mother reports also being concerned that =a-cher only feeds him junk food, states that she has a Hard time getting Mickie Zo sleep_ at nicht by herse1 f , and wcrr_es that fatter. W2.__ not take Qood care cf Mick=els teeth latae on or `eaa `zn [11m 1 Michael; = avis, Jr. Psychological Evaluation 'Page' Twelve 4/30/94 everyday. Mother states thoroughly enj oving Mick_e , descr_ih i n'c their time together like a ho liday. Although superficially mother presents a good facade, her pass ivi tv in interacting with. Mickie, her failure to obtain medical treatment for Mickie, some inconsisternc=es in her reporms regarding abuse charges, the distortions in perceptions and thought processes are disturbing. The TAT revealed serious problems with thinking, perceptions, judgment, and decision making. closer inspection of mother ' s psychological testing reveals a narcissistic-core in mother where she is focused predominantly on getting pleasure including sexual gratification, almost addictively. For example, on the sentence completion, she responded to the sentence "The thing I want most of all is" with "have fun" ; or "When I thought of growing up and getting married" with "I wanted to be in love forever. " When she is not stimulated or forced to deal with more routine, mundane tasks, mother seems to zone out (i. e. potentially leaving Msckie unprotected) . Her relationship with a male takes on primary importance. to her. One has the sense, in spite of what she says verbally, the child is frequently an extension of her, coming second in imnartance. Having fun , being narcissistically gratified. seem more important to her. Thus she has difficulty put ting herself out for someone else or seeing things from. their perspective. In addition , mother' s projectives revealed problems in relating closely to others. She also appears to have quite a bit of ambivalence about being a parent. She seems more identified with the child who wants to play at being a mother for awhile, then run outside to play herself while someone else is at home taking care of her physical needs . For ins Lance in one TAT card, the central character hands the baby back to her mother and "runs outside to play"-; on the blank TAT card, mother projected a fantasy around two fairies floating out to play together while their mother stays behind- "•waiting for them, cooking dinner. " Mother' s response to the Parenting Stress Index also raises some concern. Whereas mother rated herself positively on most .parental characteristics , she rated Mickie notably more negatively on . child characteristics . In fact, the significant validation on the Adaptability. Scale (90%) in conjunction with the high score (80%) on "Reinforces Parent" raises strong possibilities that mother is feeling . a lot of unacknowledged frustration in her relationship with Mickie. Mickie is an active , energetic child (like father) with a strong mind of his own who is likely to need an active involved parenting style. Mother for the most part however appears unaware of these -issues . } rlichael ,;?.,;'.q.vis , Jr. : :., Psyc�'�ol mal Evaluation page • Thirteen 4/30/94 Although some of mother ' s and maternal grandparents ' allegations may be manipulative, for the most part mother appeals unaware o` her lack of integration. She has the public facade of p rc=erness , but she has not looked at her inner narcissistic core and .add_ctive style. This narcissistic . personal charc-icterolcaica 1 patter: results in passivity and a lack of awareness of Mickie ' s meets ar- times , possibly putting him at risk. SUMMARY AND RECOMMENDATIONS Although both parents described themselves as "excellent" parents and demonstrate some caring for Mickie, each also possesses a lot of distortions in perceptions and thinking as well" as liabilities in being Mickie ' s primary caretaker. Father appears more ccnnec-e d and emotionally invested in Mickie (going overboard sometimes) whereas mother' s narcissistic character structure blinds her to. some of Mickie ' s need's which could result in neglect . On a behavioral level, mother is more even-tempered and easier to deal with than father whereas father has demonstrated disturbing assaultive behavior when under high stress or steroid medication. Yet mother looks like she may be more frustrated by Mickie, increasing some risk for Mickie of being abused. Thus it appears to be in Mickie ' s best interest to continue with the current Joint custody arrangement until he starts school . To date, Mickie appears to be a happy, adaptable child who has accommodated to the transition between two warring conflictual parents. Behaviorally, Mickie appears to prefer males (father or boyfriend) although he is also attached to mother. Thus , the custody arrangement should faster Mickie' s attachment to both parents. To each parent' s strong credit, neither parent has objected to me about the weekly six-hour roundtrip entailed in picking up Mickie, although each has been stressed by their confrontation with the other. Based on the high intensity and animosity between the parents , it is strongly recommended that a Special Mas`er be appointed to deal with parents ' problems in working tcgether conjointly. Mother continues to wish father has no contact with Mickie. Father, on the other hand , occasionally expresses desire to coparent with mother, but then gets carried away in verbal tirade against her. Michael D ;:is, Jr. Psychological Evaluation Page Fourteen 4/30/94 The following specific recommendations are as follows : I. Father continues -co have physical custody of Mick--:, a uondav 6 : 00 p.m. to Fri day 4 : 00 p .m. ; mother' to have cus LcdV t ridav 4 : 00 p. m. to Mcndav 6 : 00 c .m. 2 . The exchanges will continue to occur a` t2ne Police station at the receiving parent ' s locality. 3 . Holidays are to be alternated between parents , but mother granted Mother ' s Day and rather granted Father ' s Day . 4 . Father should be ordered to remain i n individual psychotherapy. 5 . A Special Master should be appointment to settle conflict between the parents, including transition issues and allegations against each et-her. 6 . Random drug testing to be cbtained on mother. 7 . Both parents shall refrain `_cn making negative comments about each other in the presence cf the child. V v� MARLENE BE C=NG, Ph.D. Licensed Psychologist PSY4550 , PETITIONER'S EXHIBIT MAItLI?NE BI:CKING, I'11.1). Licensed Psychningist PSY4550 47 Quail Court, Suite 212 �J W;ilnut Creck, CA 94596 . i:.. (510) 930-7664 r CHILD CUSTODY RE-I;VALLIATION Namc Relationship Birth I)alc Ave Michael [)avis Father 09/29/60 35 Elizabeth Iloy Mother 05/25/66 30 "Mikey" Davis Child 12/07/92 3-�i Case No. D93-00892 Date Report Prepared: 8/11/96 REFERRAL .Mikey, and hitt Parents were referred for "court-ordered" re-evaluation. PSYC11C LOGICAL '11"STS UTILIZED Rorschach Inkb1o( Test Thematic Apperception Test (TAT) Sentence-Completion (S-C) Minnesota Multiphasic Pcr:tionality Inventory - 11 (MMPI-2) Millon Clinical Multiaxial Inventory _ III (MCMI-III) 5CIIE'D1.11F 01" PROCEMURFS Names 1)ates Time Contact Michael 05/29/95 1 hr. Interview Michael 04/2"%/9G 2 hrs. Interview Michael 07/26/96 2 .11rs. Rorschach. TAT, S-C Michael MMPI-2; MCMI-111 Michael Interview Michael Interview 3 Davis F:tnuly Child C'uslody Rc-l"Va11.13tion Pabc 2 8/1 )/96 Namcs Dates 'time Contact Elizabeth 06/02/95 1 hr. . Interview l. lizabeth 06/26/96 2 hr:s. Interview Elizabeth 07/05/96 2 firs. Rorschach, TAT, S-C Elizabeth 07/26/96 '/ fir. ► Intcrview, MMPI-2 Elizabeth 08!07/96 1 'A III-S. + Interview, MC N41-111 Mikey 07/19/96. 1/3 hr. Structured Play Observation Mikey 07/26/96 1 fir. Structured flay Observation Mikey 07/29/96 1 hr. Structured Play Observation Mikey 08/07/96 1 hr. Structured Play Observation Mikey 08/09/96 '/i hr. Structured Play Ohscrvcition Mikey-Cousin Jakc 07/19/96 '/z ht'. Play Obticrval ion Tina-F:i.her's girlfriend 04/29/96 '/z hr. Interview Thomas Iloy (grandfather) 05/03/96 1. hr. Interview FAMILY OBSERVATIONS ANI) TRANSI'T'IONS Mother/Tom, Mikey 06/02/95 1 hr. family Ohscrvalloll. L)oodhyc to father Fathcr/Melissa, Mikey 05/29/95 1 hr. Family Ohscrvalior] Jesse, Mallory Mother/Tum, Mikey, 05/03/96 1 hr. tardily Observation, oodbyc to nitm) I3ailey Father, Mikey 05/03/96 '/z hr. Observation of transition to father Father, Mikey 05/10/96 'h hr. Family Observation, poocibye to dad Mather, Mikey 05/10/96 10 mins. Transition to Inothel' Mother, Mikey, Bailey 05/17/96 'f2 hr. Fairli)), Observalion, wodbye to.1nom Father, Mikey 05/17/96 'fz hr. Tra.n:;itinn to father ' Davi:; [�anri{y Child Custody Rc-i:valu,111011 Page 3 8/11/96 Nantes Dates Time Contact Mother, Mikey, Bailey 06/28/96 '/z hr. Family Observation goodhye L rnom Father, Mikey 06/28/96 10 mins. Transition to f.rthcr Father, Mikcy 08/09/96 '/2 hr. Transition to father Generally then, Mikey was observed 3 firs. 10 minutes wish each Parent and/or extended family. On 2 observations (6/2/95; 5/10/96) totalling I ilio rr 10 minutes, Mikey was ohservccl dropped off by father to he with norther. Dour appointments (5/3/96; 5/17/96; 6/28/96, 8/9/96 for a total of 1 hr. 40 minutes) consisted of sessions when Mikey was observed going from mother's custody to father. In adc;'tion to the scheduled appointments, i consulted with the following individuals: Lisa Salymr.n, Butte County CPS; Chico Children's Center, Mikcy's medical care facility in C'hicn: Charles Crain and Gayle Shiftman, father's probation ofliccrs, John Kincaid, f'li.l)., fat.her's therapist; Ur. Frieso n, Mikey's pediatrician in Antioch; Shannon, Director of Learn and flay. Mikey', preschool (8/1/94 - 7/6/95); Janic, day care for Mikey (5/94 - 8!94; 4/96 - 8/96): Chet Bollard,, father's employer; Stacey Anderson, Contra Costa County C1'S and personal reference for father. f also spoke with Mrs. i'cggy Davis, paternal grandmother; Jennifer Young and "I'heresa Jones, father's sisters; Mrs. Paula Davis, paternal aunt in Salinas; father's current and p1-cvi0us girlfriends, Tina, Melissa and Kathryn; Mrs. Judy Morris, maternal grandmother; Caroline Uanderpoo 1, stepfather's molher; Sybil, pastor's wife of the church no>ther attends with Mikcy; Anna, mother's friend; Annelle Wolfe, mother's friend; Rose BILITInkall, mother's friend. I have also reviewed the following documents: • My original psychological evaluation (5/11/94) and letter (1/27/95) to Paula L.orcntzcr • Court Order regarding Custody, Visitation, R/O and Rcsults of 'l'rial - Paul L.orentzer • Court Order (6/6/95) re Custody, Visitation, Support • Cout•t Order (5/1/96) Denying Motion to Remove Counsel for Minor .nal 1�urthcrOrders • Cimtra Costa County Superior Court, Dull Case History of D93-00802 (5/31/91 -4/4/90) • Contra Costa County Superior Court, Case History of 94-01954 (7/5/94 - 2/27/9(1) • Contra Costa County Detention Facility - history of Inmate - 12/23/1)4- Contra 2/23/1)4Contra Costa County Sheriff's Department Report - 5/10/93 • Kathryn Sizemore (6/21/88) Order to Show Cause and TRO. (in Mich.+cl Davis Davis I7arttily Child CuStod)' I:c-i:valuation Page 4 8/11/96 • Kiniherly Davis (5/3/91) Order to Show Cause and FRO • Terri 131'uno (3/18/96) Order to Show Cause and TRO on Michael Davis • Ferri Bruno (5/12/95) Order to Show Cause and TRO on Michael Davis Terri Bruno (4/12/95) Order 10 Show Cause and `I'IZO on Michael Davis • Michael Davis (4/15/95) Order to Show Cause and 'IRO on 'Ferri Bruno • Michael Davis (2/24/94) Withdrawn Not Guilty Plea - Order fOr Probation Probation Officer's Report and Recomnr.endations (6/5/96) • Court Order (6/11/96) Dismissing information and Deeming Offense Misdemeanor Antioch Police Report (1/12/95; 1/3/95) by Liz Morris Iloy • Chico Police Report (5/2/95) regarding Alleged TRO Violation and Threatening Telephone Call (7/10/95) to Tom Hoy • Walnut Creck Police Report (7/11/95) regarding alleged threatening telephone calls to Michael William Davis, Esq. • Monterey County Sheriff's Department Crime Report regarding alleged child abuse (4/21/96) • Letter (8/17/93) from Elizabeth Monis--1loy to father's employer. City of Danville • Declarations of Gregory Abel (5/3/95; 6/2/95) • Declaration of Judy Morris (6/2/95) • Declaration of Tina Borris (1/21/96) • Declaration (.)!, William Davis (6/1/95) • Declaration of Tom l loy (4/3/90) • Declarations of Elizabeth Morris-1loy.(8/27/93; 6/6/95; 4/3/96) • Order to Show Cause and Declaration for Contempt (2/13/96) Responsive Declaration to Order to Show Cause (4/23/96) and 1.)CC1:1•c.10011 of Michael Davis • Motion for Modification of' Custody, Visitation (7!18/96) •. Chico Police Report (7/24/93) .by Elizabeth Morris, . Mernorandurn of Points and Authorities in Support of Motion for Order Requiring Plaintiff to F"urnish Security (11/20/92) - Mr. and Mrs. Morris lawsuit against Nctco l'oods, Inc. • Award cif' Arbitrmor (3/16/95) • Complaint (C94-01954) - Property Damage, Personal Injury, Assault and Baltery, Conversion, Harassment - 5/6/94 • Request for Admission - Set I to Michael Davis • Answer (Michael Davis) to Interrogatories - Set 1 • Request for Admission- Set I to Elizabeth Morris • Response Morris) to Request for Admission - Set I • Response to Admission and to Interrogatories by Elizabeth IFoy • Issue/Settlement Conference Statement - 4/14/95 • Notice of Amount of General Damages Being Sought.(4/26/9`) J.. Davis Family Child Custody Rc-l,valuatiorl face 5 8!11/96 ' • Log of Occurre'llces Where' Michael Davis Threatened f;liraheth I toy ::Incl/or family • Declaration of Kenneth Morris (6/2/95) • Memorandum of Points and Authorities on Opposition to Duf*Cndant's Motion to Set Aside Default Judgrnertt (7/20/95) • San Ramon Regional Medical Center Report (5/10/93) • Letter ( 1/10/94) to Mr. President, Attorney General J.Inct Rena, Judt,C Mirrney and DA Office by Mr. and Mrs. Morris • Letter (5/4/94) to Judge Flier from Mr. and Mrs. Davis Petition for Writ of Mandate • Judgment A Ner Trial - 7/18/96 • Notice of Intention to Move for a new "Trial (7/21/96) Transcript of' Videotaped Proceedings - Order After blearing - 5/18/95 • Letters ( 12/5/94; 7/25/96) form Butte County DA to Michael Davis • food Stamp Information - Medical Eligibility of Mikey Davis • Butte Cclllegc Academic Transcript of Elizabeth Iloy (fall, 1985 - 1989. 1992, 199-1... 1995) • Transcript from Chico State for Elizabeth Hoy fall, 1995 • Transcript fro►n Butte College (1992-1995) fclr Tom I loy • Michael's schedule with father • Reference Letter (6/27/96) from Mari Ennis-Applegate till' l.ai7.ahcth llily • Letter (4/17/96) from Leonard Schmitt, DDS • Letter ( 10/14/94) from Richard Cohoon, Ph.D. • School pocket from Mikey's Current preschool Chico Mother's Out) Newsletter.7/96 • Solar Swim and Gym - Swimming Skills Test on Mikey Ilomc vidco Icy mother with Mikey at Chico and maternal grandparents • Home video by father of his residence • Mikey's baby food • V;11'IUUS pictures of Mikey STATEMENT OF i'ROf LEIMS Parents' current .joint custody l'or Mikey appears untenable as parents' :1 year hattle with cac:h other continuirus unabated, with no sign of'resolution. Father rages about 11100Ic:r's alleged abuse; (suspicious burn 8/93), neglect (3 days hospitalization 2/94), her "loser" "low life:", Itc., her perceived attempts to obtain custody of Mikey by throwing him in jail, ruining him lolally - emotionally, financially and professionally. Mother presents as more reasonahle; and supportive of co-parenting. Yet, mother's actions undermine her words as she has brought a civil lawsuit 'Davis Family Child Custody RC-I valtl;M0ll Page 6 Against father, repeatedly sought prosecution of father and nrldC i•el-)orts llle;_1irrl�1 vif)1.16011S to police and father's probation officers, Mikey's clay care, father's work, and ri,cerllly initialed CI'S evaluation against father for suspected physical and sexual abuse. Questions regarding father's emotional, lllental, physical stability, as well as Ills- history of violence, or mmil, emotional fitness as a parent are raised. Mother dC',cribe, I-ather as art c.;ratic, unstable, sick, malicious, and elcvious human being. On the ether limed, mother's motive in requesting custody is questioned i.e. is mother primarily focused on Mikey's needs or is she using Mikey for profit to oet welfare, housing, child support or as "halt". provoking father to lost control in order to ge( revenge. Both parents are requesting primary. physical custody of Mikr.5'.. w()ul(l lih:c: mother's visitation to coincide with his work schedule (i.e. the first 3 weekends of Cath rlurrrth). (:)n the other hand, mother requests supervised visitation for father. Mother reports 1'cars if she were: granted full custody crl- Mikey, father• would come after her and kill Mikey ur hr r:sclf - that il' father cannot have Mikcv. no one can. BEHAVIORAL U11DA'rE Parents' prior history was previously reported (5111/94) and will not he repeated hin-c:. insteald, the focus of this evalualion .will be on the last 2 years, During this irrtcaHm, I.-Jiz�iheth married Tom [Toy October, 199-1 and cave birth November, 1995 to her second child, a 1'111 n.rrneLI Hailey .,vho is now 9 n1oliths old. Elizabeth continues to go to school 2•-;; days a %vicek, and anticipates receiving her teaching credentials within the.next 2 years, allowim, her tea li.av : a jot; where she will Inc hortic when the children are out of school. Michael obtaint-d hitt contractor's license last year, moved to Salinas, and then went into hidinlg. Currently fie cares for ivf ikCy in a 3-bedroom home with s(ronb family support. Fie has lits own business mid has recently signed a year contract to work out of the area the first 3 weekend a month, allowing,, hint to he fairly as to Mikey the remaining time when Mikey is not in preschool. NNfilcey is cnt-nNed in preschool Monday. Wednesday, and friday 9- 1 . Mother has Mike), crit-called in i lead Starl 1'nr i';ill, 1996. As expected. whenever there are jrey area in the court orders, parents get into Irouhle. January, 1995, when lather withheld 2 visitations from brother because Mikity was sick, then ol•fc:red make-up time, Liz filed a police report and insisted on prosecution; when IIrlichael moved to Salinas (5/4/9.5) and instructed mother (5/7/95) to pick up Mikey at his, Salinas day care (instead of .Antioch day care) and there was a misunderstanding (5/21/95) of' the modified court order (5/i 13/95) regarding the day and time of pick up, mother made police report:; father was violating 'Davis i=aInily Child Custody Itc I::valuatii�n Page 7 8/11/96 his TRO by coiling up a day early. Mare disturbing however are Ilse allegations of h lrassnlenl. F.lizabeth and maternal grandparents report Michael drove by grandparents' he>usc (6/23/93), rimed a gun at their home, and made approximately 25 phone calls, thre.itening to kill or fuck Ihcn1. Apparently, ihcre are no police reports of Ithe alleged gun incidcnl or Iltreatening, phcme calis, no tape-recorded messages o1'Michael, or witnesses other than family to substantiate these Charges. Michael denies these allegations, staling; he cannot even call to make custody arrangement or talk to his scin without someone reporting he is threatening to kill them. He reports being so scarce of their attempts to ruin him that he initially fled to ill,: "canctuaryof his aunt's home in Salinas (5/95), then (February, 1996) went into hiding. Elizabeth repeatedly made reports to police officers and the probation department father violated court orders, mncle threatening phone calls, etc.; she appears to have sent it lengthy, discrcc.litin; letter to fiathc r-'s employer (City of Danville), disclosing his violent history and alleging various; business impropriety.- l'lizaheth and her attorney humiliated Michael by reporting his }��,����f r,•�►r,: �T, n, Mike day c 1rlre; iaizahcth filed a civil lawsuit, as �ti�cll as contempt charl;cs ;tf+ains>t Michacl for failing to rsclose his whereabouts; recently, Llizabetl) has filed 2 abuse Charges against Michael for sexual and physical abuse of Mike +ichiie is :5tres.Sc l .h• osis"ns�iii `'t .r: itcc iittiWS ffinseli"`'fi ti i1elri w� uie ' Pr: court; Yet he !'ails to accept responsibility for his part, showing pour control of- .judgment in monitoring what lie says. Iic.Tg es..oif n:;ven al tirade, a a nst miilf ci r putting. Mikey cm Medi-Cal using hint to get food and lrousin while he secs himself as tri to,,. zrpt� —M,ikc — =.ire.;..,,�a:; ,.. . .".` .� "f.Jci��l l:�:. ..f ser:�;imrn ;t tlicww,orld..11c::ti been_liurned' lids italize�rl :ri itnrnul ilc.cl l :�-;:.tlr.cSc leo>Icq i,.��_::��:::;�..-�::a,:s.vi '-�e-:...:w,J.e:n,.;s:.P�:..:..,::....,.,...�3.Kz;..,!w5!�'+�-:�x'+aN•�"da.,,J.B...._ 1 1 to get sornenne to.:lisfuid do Something;hcfore to s tc Mother's civil litigation against father was initiated May, 1994 for 1ss:nrlt and hattcry, harassment, and con{'iscatiun Of personal properly. /111houg11 an arlvn.ttor ;iwarded l liraheth $2,100 for daina!;es, she proceeded to trial and obtained a $18,500 sell lenient (7/16/96). father has requested (7/26/96) a retrial. Despite mother's numerous allc"atiorrs, l'ather's probation ended i=ebruary, 1990, based on his "good conduct and reform." Furthermore. his felony offence (273.5 PC Corporal injury on Spouse) was reduced to a misdemeanor (6/11/95). Ari allegation ilial Michael was making threatening phone calls to mother's•attorney and stcp{'alhcr was nest substantiated by Walnut Creek investigation (7/11/95). Collaterals rc-port. Michael has made a noticeable turnaround the past 3 years. lie is described as it hardworking, rcliahle C111PIoyce who has matured and calmed down. Significant females in his fife report no violent interactions will) him; in fact, in spite of past fights or disagreements with him, they arc stron�z supporters of father; although it is .acknowledged that father has a had 111011111 Ur' t1:i11pCr', ll!, r1 >t cticcttY°�iti ;. Davis family Child Custody Ite-I;V;IIU;Ir1011 Page 8 8/1 1/96 Mother reports she became suspicious Mikey was heing sexually nlolr.sled f"'ehru;►ry, 1996 when Mik:y had an erection while she. was changing him and he stated "Nlonl. i eat. it." I'Vfother reports Mikey then said "Come on, come on, eat it" and then looked guilty aild stuck out his tongue like he was trying to talk her into oral sex. She thinks Mikey then made some comment about father hurting him. Torn, who is also present, reports the incident Occurred atter Mikey got out of the bath tub and recalls hearing Mikey say "Mom, kiss it, suck it or licl; it." Bulle County CI'S was called and interviewed Mikey (2/12/96). Subseduenily the case, was clnsed as unfounded. When interviewed by Monterey County Sheriff's Department, 1-aizaheth admitted prompting Mikey for the answers. July 8, 1996, Elizabeth brought Mikcy to BULtC County Ci'S to document bruising she suspecting occurred by father using a belt or strap on him. Since Mikey went back and forth ("mommy did it", "daddy did it", etc.) the bruising was barely visible with a non-suspicious appearance, and Mikey's presentation was very limited and none credible, the case was again closed as unfounded. Mother reports Mikcy has not hClal exposed to any sexual activity (movies, magazines, sexual interactions hetween her and 'Tons) at their house. Michael denies any sexual or physical abuse of Mikey, seeing it as rllother's auempt to manipulate Mikey. He suspects Mikey.liears others "had mouth" hall because lvlikcy Willetimes acts very clingy or protective of him if'Tina or someone says something negative ahuul hien. On the other halal, maternal grandparents suspect father "brainwashes" Mikey because Mikey appears less excited about coming over to see thein. Over the last couple of years, Mikey is reported to he .developing normally allhough he. has sustained a couple of injuries. April, 1995 while mother was shopping , 13ig five SportIn,' Good Store, Milcey full on some weight lifting equipment and needed 4-5 stitches. July 27, 1996, Mikey received a second degree burn when he fell on his motorcycle while father was in the: process of repairing it. Mikey also had one cavity. Generally, Mikey is descrihed as an, active, happy, well-adjusted 3 year ') month old boy. i3y mother's report, Mikey is doing well in all areas including; speech, and adapted well to the joint custody routine although she reports Mikey acts sometimes like he is living '? lines. W en Mikev is with mother, he reportedly does not talk about his life with faiher and vier veru. Dad . expresses more concern about the joint custody arrangement I*or Mikey, primarily 11l:CauSC ol,his perceived concerned over Mikey's safety, Mikey's need to settle clown, and some possibIc spt;ech problems being monitored by his pediatrician and neurologist, Dr. Sichell. Mikey is 1.1 0 reported to tune-out and ignore requests; his day care Provider has quesnoned his hc;lring; and his •..ant expresses some concern about what she perceives sonutirllcs as a "hc llo>vness" or "emptiness." Melissa, father's previous girlfriend, who picked up Mikey (renin mother last year at transition, reports concern about Elizabeth's attempt til nlarlipulatc Mikcy to rC5isl lcavintt, her. On one occasion. Melissa reports Elizabeth waking Mikcy up 1'1'0111 a .deep sleep by rolling, Ivtikey into her daughter's arm; when Mikey startled and started crying, I:aitahcth irnlnediately / Davis f=amily Child Custody Re-Evalualitln Page 9 8/11/96 whipped the video camera out in order to document Mikcy's "distress" in Iciving her. Maternal grandmother and mother report Mikey firequently' cries when it is time to Lo to father while father, Melissa, and Tina report the reverse. Mikey is rcpcarted to he doing well socially. He plays with ;r 5-6 year old nci,,hhor hoy on a daily basis, generally outside, when he is at mother's. I"athcr's day care reports Mikey gets along very well with children. Ile has a particularly strong; t•ie to his cousin .lake who is 6 weeks younger than himself. They reportedly often spend days together in day care and up to overnights a week when Mikey is with father. Father is helping; to coach Mikcy's soccer team and also takes him to swimming lessons 2-3 tirnes a week. Both parties are described as wonderful parents by collaterals. lairabeth is admired fOr- her loving patience, her pleasure in playing games with the children, teaching; Mikey songs and providing education stimulation. Elizabeth reports loving to lake Mikey and Railey to the park and her various Chico Mother Club_ activities. ichael is% epeatcdly::desc�r�it.�c�l;.as,:;a�v,ery~-• int ressiv.e `clev.oted .dad,.,who: is.ci az il� ui''Ni ik'eNiie.;whose;` kl' ( 'I l::rtll;rt:;f`ie overt�c�ard fot.azi.tudote :.tot much,ave tAmn,,>pr is to .' ettii.elz�;-,-No:<�ne has:ob5c t;yr:d:Michael:;:::_. •A../— 4r .. - ... .. ...\;. �r^w!.w.,. Yat+�IM1`4✓r::��.Ct�.'�!Ii�4Jr:Irl.�1.u.L�:.+Rri..i...:r'`..:w.re...:.:�..v.�.: _ ...,a .rw..._...r show:the-slighlest `sign o[' 9. -i is dcsc ribed as cxtrenidly,; hilnticglFao_ f�►ttic; � .;_- , . wlienevem,da'd is artiund;::Mikey:. reportedly:refuses to.have:much .to ilo wrth-.any `other ;[dolt Elizabeth believes she should have custody of Mikey because she has:'st;iblishcLl a sl;rhle, lirving family unit with a sister ;111d step-dad for Mikey, in a 2-bedroom hone: with a hacky lyd. Paternal grandparents have a pony for Mikey and a trampoline ern which he loves to hounce. Mothcr believes father is true erratic, violent, and cnultion;rlly unstaltic 10 parent IVlikcy. She reports being stressed and "nunlh" by father's harass►nent. EVALUA'riON h'lkey is an active, motorically orientated child who Physically and IcnlPcranlenlally resembles farther = he looks and acts very much like father which obviously plca.S;es clad very nurcll. The two of thein interact physically, verbally and playfully very happily togelhcr; there is a very strong bond with lots of glee, excitement, joy and energy. WheJ`.jhe)' arc,tcrt�clher tltey��:tiuUJ flow:,Bich time Mikey was delighted to see dad — there.was nb iesttil;incc or sadiress evulcilt about leaving mother. Instead, Mikey would dash off, with little backward ! lance to mother. While writing aline with me for father to arrive, Mikey sang and stated "I happy to see daddy" but repeatedly failed to respond when I would question him about b6n>; sad at 1L:3%'1111; 1110ther', "sister" or papa. Although the attachment between Mikey and father was obviously 'Stronger, I .. Davis Family Chits Custody Rc-I"valuation Page 1 8/11/96 has rebuilt some bridges with hitt father. I tis family support system has Been very helpful in dealing with his custodial crisis. In spite of Michael's faults, it is clear his heart is in the right place in regards to Mikey. Ile is overly identified with Mikey, yet caring. Around Mikey, father becomes loving, warm, mellow, patient, soft, etc. He clearly loves talking about Mikey, interacting with him, taking him places, putting himself out for Mikey, or being a parent. Michael is very achievement orientated, recognizes the need to settle down, to provide more physical stability for Mikey. Ile is open to input from others (excelit for the need to maintain verbal control) and has set up a strong support network for himself and Mikey. Elizabeth appears more "settled in," comfortable, and happy with life and her support system. Marriage appears to have been good for her. Psychological testing shows sonic notable changes suggestive of less disturbed, narcissistic functioning. She was more engaged with Mikey, appeared to experience more pleasure with him, and seemed more confident intervening with him. On self report (MMPI-2), mother presents herself as well adjusted and not experierlcril" any type of stress, denying depression, anxiety or worry. As bel'ore, there are signs Elizabeth resists dealing with the serious side of life, finding introspection, rules, or sell--discipl irlc tc-diUUS. When things get difficull, she tries to escape into fantasy, deny reality, or look to other to elect her needs instead of assuming responsibility for herself. She is very defensive about looking at herself, attempting to present a facade of "normality" but lacks the energy or resources to sustain the effort under scrutiny. Repeatedly on the Rorschach, L.Jizahetli would project popular S."-hole responses, then cut oil some part. She repeatedly cut-off or simplified experiences perceived as ambiguous or complex. Thus she is prone to experience difficulty interacting in her environnlcnt, without a lot of." exlernal support, since on her own, Elizabeth disregards too ninny aspects of a situation, escapes too often into a fantasy world, or acts out unconsciously. Base%i on Elizabeth's defensiveness and limited self insight, her actions tell more than he• words. What becomes apparent [hen is that, when it comes to caring for Mikey instead of stirring up father, she does not look as good. for instance, although Elizabeth picked up Mikey approximately 15 times across the street from his day care last year, she never once called to ask how he was doing, to request staff to inform paternal grandfather waiting 1-2 hours outside _ with Mikey that she was running late, or come to observe Mikey, in spite of an open invitation; _ instead mother's only contact was to humiliate father by reporting his abusive assault on her. During my observations, mother was more interactive with Mikey than before. Yet in our Inst session, she was so focused in telling me (within ear shot of Mikey), that she fear:~ father would "get" Mikey or herself if'she were awarded full custody; she forgot to say goodbye (fora week) to Mike.y. When asked detailed questions about Mikey, she seemed less knuwledbeablc about him. 1-2 years ago, mother reportedly stated she was ready to let father have cus16dy. I"'inally, bavis Family Child Custody Re-1-valuation Page 10 8/11/96 also observed Mikey responding well to mother. He seems comfortable and responsive to her. Mother was good about giving Mikey choices, "teaching" him colors, numbers, efc., songs, and recognizing his needs for limits. Much of Mikey's play at transitions between Parent focused on a pop-out snowman who repeatedly disappeared — symbolically acting.out his own coming and going. Other play associations involved battles between parents, with each one threatening to kill the other. Although Mikey appears behavioral to transition well between the parents, I observed some speech problems (articulation errors .and less communication), sonic tuning out, and sonic "blankness". At this point it is too soon to determine if Mikey may be showing early symptoins of attention deficit disorder, or whether his behavior reflects some attachment disorder associated with the split custody arrangement, his need for more stability, or sonic difficulty in mother- child bonding. It was my impression there was less of' this "detachmenl" when Mikey was interacting with dad or his cousin Jake. Aside from one interview where Mikey appeared to come coached from mom to report indiscriminately "daddy did it," to various questions, 1 saw no indication father was abusing Mikey. instead, Mikey's projective free play,'his various affective non-verbal reactions, as well as his response to verbal questions, (open-ended, as well as directed) show no evidence of ahuse. Yet, I did have concern one session mother appeared to be teaching Mikey father wits abusint; him. His responses that session appeared automatic; dissociated from his affect, inappropriate to the questions asked, .or the location of the bruise to which I was pointing. Throughoul my contact, Mikey consistently denied with convincing affect or other symbolic play, any sexual experiences with his "weener" or other people's. Micheal continues to present as a highly reactive, naive male who -is lax about controllinO his :motional display or verbal output. He frequently calls attention to himself by his air of imperturbability and the intensity with which his feelings are expressed — particularly since his judgment may be poor, his reactions oppositional, or his thinking loose and clistorted. It is easy to pull his "chain" because Michaelis so fearful of losing custody of Mikey, or "bait" him into believing one is messing with him or Mikey. Currently he is under it lot ol• situational related stress and subject to intense experiences of depression and/or affective disruption. I Ie sometimes appears to have "lunncl vision;" thus in ambiguous situations, he focuses too 011e11 on irrelevant detail, missing the overall gestalt. Other times he tries to get reality to coi form to what he wants to believe or perceive. His thinking can be loose and his reasoning hard to follow. Ile Can be very defensive about revealing himself. Although Michael can be intense, negative, angry, and devaluing of' mother,• he has managed to maintain behavioral, if not vcrh jj, c t Furthermore, there was no evidence of psychopathic tendenciesst;, ...cine _:. - f utnoyrng=tfiart=flireatcriing or'violent:` lie=:appears to show same Calm ing down or maturing and by vis I~amily ' Child Custody Re-I ValUatinrl Page 12 8/11/96 Elizabeth ni alicgations was unable to substantiate e.g;. Mikey was returned to her care /2/96) with an infected, pussy burn; Mikey's first c3vity'7Y.IS due 10 falher's rngligcnce; father's sister Jennitcr reports father is often "mean" to Mikey; Mikcy repeatedly cries and resists going to father for visits; she continues to experience post-traumatic syrnptorrrs associated with father's assault of her while her testing revealed no stress; paternal grandparents Cavur (licit- other grandchildren over Mikey; fatller_ is sexually-physically abasing; Miley. RECONIMENDAnONS This case is a disturbing one for both parents seem more invested in destroying cath other 111,11 recognizing Mikey's need to be in a safe protective: spot, out of the middle of the cross I'ire, I'rce to love each of then(. Since mother's apparent willingness to use Mikey as "hail" to incilc father' and to teach Mikey father is sexually and physically abusing; hint, appear more psycholo-Ically damaging, 1 did not see her as the preferred custodial choice. It is IIIM Mikey ha:; a stronger emotional bond to father, and ape^cars to he the type of child who docs better in a custodial arrangement with the father. In spite of father's' temper and history of violence, he appears very invested in raising Mikey properly. He has a strong family support syslcm in place, i5 open to input From other's, has established a positive ongoing, ther:epeutic: professional relationship and has readjustedhis work schedule to accommodate Mikey's needs. Thus I recommend father he given physical custody of Mikey with mother to have visitation while father works (first 3 weekends each month). This recommendation is based on the condition father continues in theritpy with Jahn Kincaid, Ph.D. Hopefully, this arrangement will diffuse the parental hattle, allowing; father to support Mikey's needs for mother. I did not sce evidence mother was abusing; drubs or an "unfit" mother — mostly she sceins unconscious ahoul usinl, Mikey to act out her anger and revenge at father. Because of the physical distances between the parents, it may be advisable 11.1 SCI tip ;.l h0lid;1v schedule where the holidays float, i.e. mother would he entitled to take whichever holidays fall on a Monday or Friday on the first 3 weekends per month, with the.exception that she would be entitled Io Mother's Day each year, Christmas eve odd years,.and Cht'ititrtr;rs d;iy cvcrr ycar:ti. Each parent should be entitled to 2 weeks vacation with Mikcy each sunu»cr. with 2 month written notice to the other. Legal custody would continue to be shared. Mother would pick up Mikey I p.m. Friday from day care; father would pick up Mikcy at C.fIico police Station 6 p.m. 2Sunday. It is also recommender! Ilia( Mikey has a hearing; evaluation to rule out any problems and th�rt father follow through on recommendations for a speech prog;rain for him. MARLENE` i ECKiNG, P11A?. Licensed Psych(.rlogist PSY4550 Ol 19 Cru rT <; p Ln 7 ✓7 CD •�' (`;,..� � ,off z t\ • r 1 1 l 1 OFFICE OF THE COUNTY COUNSEL SILVANO B. MARCHESI COUNTY OF CONTRA COSTA ,5 �_ F= �1�+ COUNTY COUNSEL Administration Building 651 Pine Street, 91h Floor !�''= -�•,o SHARON L. ANDERSON a` - " ` Martinez,California 94553-1229 �� _� :_a,; ;, CHIEF ASSISTANT (925)335-1800 GREGORY C. HARVEY VALERIE J. RANCHE (925) 646-1078 (fax) �,�, .. y��n `' ` ;`O ASSISTANTS ,y rA Colo NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM May 1, 2008 TO: Michael Davis 2981 Saddle Drive Oakley, CA 94561 RE: CLAIM OF: Michael Davis Please Take Notice as Follows: In regards to the claim you submitted by mail on April 21, 2008 on behalf of Michael Davis, portions of the claim arc timely and portions are untimely. The portions of the claim prior to October 21, 2007 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901. and 91 1.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to October 21, 2007 were not presented within the time allowed by law, no action was taken on those portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. The only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, Leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. SILVANO B. MARCHESI COUNTY COUNSEL Monika L. Cooper Deputy County Counsel Page 1. CERTIFICATE OF SERVICE BY MAIL (Code Civ. Proc., §§ 1012, 1013a, 2015.5, Evid. Code, §§ 641, 664) I am a resident of the State of California, over the age of eighteen years, and not a party to the within action. My busi gess address is Office of the County Counsel, 651 Pine Street, 9th Floor, Martinez, CA 94553-1229. On ,:1 ?.Ob , I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing the do6ument in a sealed envelope with postage thereon fully prepaid, in the United States mail at Martinez, California addressed to.Michael Davis, 2981 Saddle Drive, Oakley, CA 94561 as set forth above. I am readily familiar with Office of County Counsel's practice of collection and processing of correspondence for mailing. Under that practice, it would be deposited with the U.S. Postal Service on that same day with postage thereon fully prepaid in the ordinary course of business. I declare under penalty of perjury under the laws of the State of California and the United States of America that the above is true and correct. Executed on at Martinez, California. Kathleen O'Connell cc: Clerk of the Board of Supervisors (original) Risk Management Page 2 CLAiM BOARD OF SUPERV.i:SO.RS OF CON"i RA COSTA COUNTY BOARD ACTION: J Claim Against the County, or, District Governed by ) the Board o.f Supervisors,,Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to California Government Codes. p gl*im you is your notice of the action taken on our claim.by the Y Y Board of APR 2 3'.2008 Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code AMOUNT: MARTINEZ CALIF. Section 913 and 915.4. Please note all "Warnings". CLAIMANT: fA (C E,, DaV�C fA 1 ATTORNEY: �1QJ DATE RECEIVED: &� r ADDRESS: BY DELIVERY TO CLERK ON: w O yCA qq66) BY MAIL POSTMARKED: Ctb.rcA 2-1 , ZCV FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a co y of the above-noted claim. JOHN CULL clerk - Dated By: Deputy � ' .� Il. FROM.: County Counsel TO: Clerk of the Board of Supervisors Pu,hall� ( his claim complies substantially with.Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 91.0 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). (� or-1-+ Cfaim is not timely filed. 'h.- C-lerk shettid i-eitti-fi ei id that it was filed late ftH s ' (v( Other: C /�% 5 bGGvrri v r a t_0644z 2 v o �u ,tee '12", A lICA-ie•, �r'V^ Dated: By: �7CDeputy County Counsel III. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator(2) j ( ) Claim was returned as untimely with notice lo claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejectediin full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: J014N CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months froin the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attoimey of your choice in connection with this matter. If,you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of'ilris Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that. today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN-C.ULLEN, CLERK By Deputy Clerk i CLAIM BOARD O.F SUPERVI.SOi.ZS OE CON-FRA COSTA COUNTY BOARD ACTION: 1,u1 �) � 1--L�CG�s Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endo rsernents, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. ) you is your notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: Z�'�C°(?C�� Section 913 and 915.4. Please note all "Warnings". CLAIMANT: A"I TORN EY: �lCC' DATE RECEIVED: =t )�' Ll ADDRESS: :��I BY DELIVERY TO CLERK OWN: -�% BY MAIL POSTMARKED: t,( `j i"C,-6 2-1 17 FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLfT4 ler ` Dated , bu ,C By: Deputy -C,Yu� 11. FROM.: County Counsel TO: Clerk of the Board of Supervisors ( ) Tris claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should retui i claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911:3). ( ) Other: Dated: By: Deputy County Counsel i.II. FROM:: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER:. By unanimous vote of the Supervisors present: ( .) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN CULLEN, CLERK, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions,you have only six(6) months frown the date this notice was personally served or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this nnatter.'tf'you want to consult an attorney,you should doso immediately. *ForAdditional War nirwg See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that]. ann now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today .1 deposited in the United States Postal Service in N.1artinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the clainran.t-as shown above. Dated: JOHN CULLEN, CLERK By Deputy Clerk 04/18.2008 07:32 CONTRA COSTA COUNTY CLERK OF THE 3 96255592 N0.284 D02 BOARD OF SUPERVISORS OF CONTRA COSTA COUN'I"Y INSTRUCTIONS TO CLAIMANT I A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) H. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. I , D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form ree062989609rrer/rsseemed,add rsees•rrerrrrrrrrrr•rr/rr■rrNot"Dome*rrrrrrr•••■1/ RE: Claim By: Reserved for Clerk's filing stamp Michael Davis ) ¢ { Against the County of Contra Costa or ) APR 8 Child Support Services of Contra Cos ) _ district) CLLRit 30AR.D OP '2:11SORS (Fill in the name) ) Co.1TRA The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 25,poo_oo and in support of this claim represents as follows: I. When did the damage or injury occur? (Give exact date and hour) I From 2003 to present 2. Where did the damage or injury occur? (Include city and county) Martinez Ca. And Oakley Ca. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Elizabeth Hoy commited P rJ urY/Fraud in applying for Child Support 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage?The Child Support Division Admitted it was Fraud yet did not allow me to persue criminal charges in Elizabeth Hoys crime against me and Tina , Davis hen they are oFfusing tp cpmpl or deal with m� attorney (SEE ATTACHED) WWhhat are a names o county or district of icers, servants, or employees causing the damage or injury? Contra Costa County Child Suppogt Attorney i ALSO Tina and I met with a worker at rthe Child support division who• said that Elizabeth Hoy hAD committed Fraud but"it happens all the time" She told Tina and I,I am not responsible for the money owed and she W would adjust it,but until then I had tm make payment or I would loose my driversx License. (SEE ATTACHED) 0411812008 07:32 CONTRA COSTA COUNTY CLERK OF THE 962155592 NO.12'84 1703 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Over 20,000.00 in Child Support FEe's and 2000.00 dollars in Attorney Fee's in which I contacted :ether counties who said Child Support Services shhoul taken c r of F' aud ' asmissed. 7. How was the amount clatmel above compo e�' (1 �1e e es tm t n @ At prospective injury"or damage,) The Money I was charged Child Support when the Child Support was awarded unlawfully and the County Admits it yet refused to protect me and Tina from this crime.And Lawyer Fee's I should not hM of had to .pay. 8. Names and addresses of witnesses, doctors, and hospitals: See attached Documents and court records and the applications and laws in child support 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Current Bill over 20 000.00 Approx 12107 2,600.00 From 2003—presentApppprox.3,000.00 total a..■���■■����������■r.e■�����os�se■oo■os■■■■•�era��byaa■■■■■■■■■■er������■��■■■■■■■■� Gov. Code Sec. 910.2 provides"The claim shall be the c ant or by some person on I tis�pd-bytis behalf." SEND N077. S TQ: (Attorney) iName and address of Attorney % ) I (Claimant's Signature) 2981 Saddle Da Oakley Ca.94561 (Address) J Telephone No. )Telephone No. 925-625-0388 ■��■��■■����������r���������■•x6089■•■•e6vV91,R9a9e09aa9a5■9■■■■■■■■0998*069##*@foego. PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) f=urthermore, any attachments, addendums,or supplements attached to the claim form, including medical records, are also subject to public disclosure. ••����������a�����■•err■�■■■.��.•���a�s��o��o■■■■■o■a■oaao�o■ova■■■■■■r��■r■r�■�e���r NOTICE: Section 72 of the Penal Codeprovides Every person who,with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable dither by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000,00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding tett thousand dollars !' ($10,000), or by both such imprisonment and fine. I' jl 04/18/2008 09: 15 TEL 925 646 4683 DA SPECIAL OPERATIONS (a 003/003 ` s CONSUMER, BUSINESS,AND INVESTMENT FRAUD COMPLAINT FORM CONTCtA COSICOUNTY DISTRICT ATTORNEY - SPECIAL OPERATIONS DIVISION P.O. Box' 670; Martinez, CA 94553-0150 FpX ' PL9459 PRINT OR TYPO,IP POSSIBLE 9 Contra Costa County Department Of Child S14pp S� yzCe ,.,.. 50 Douglas Dr.Suite„100 IIAIIj'bO 16SINCID CR PLRSO OMPLAINEO OF bL�S! AlID4$q(I ��.5A5.7-.7300....................................... M�ax:tinez....... Ca............9.4.51.3...... . QE 11VHGN1lND6R (,'jZY , 2803-Pre:„,Mt„�H„Qpfltxa..Cc) ta.•Counter......... OATS AND PLACE OF TRANSACTION Child Support. Fraud by ERll. abetb.,Hqy, In„Child Supports curt Fi leS, NAtl�OP PAOOUCY ON DETICE IMVOL VED vAe CSM4RA CT dI0MaD1 ll%70,A7TACN COPT Of CONTNACj Vatious times over the last 3 years untii„the present • OATC ANO LOCATION e/NEPC tlOMOY PgID IF PRODUCT OR SERVICE ADVDRY16E0: WN QN ...................... MNCAC ,................................. •••••,,••••..... 'ATTACH COPT OF AO COMPLAINT INVOLVES MISRIKPREIEHTATIONI I CD AOVCRTI6ED 0 ORAL OTHER 1 191.0v1 HAYG YOU CONTACTED A PRrVATE ATTORNEY? .XeS.. wN0 I, ..Many. ............................... EXPLAIN FULLY' (DE6CRISB EVENTS IN THE ORDER IN W141CH TNSY HAPPENED 101 POSSIDLE, ATTACH CXTNA 6NECT IP NlcEaIARr.I This all. started out a Child Custody case in . "'r 1994 where I recievd custody of my son at 5 mo of age due to him being burnt/beaten while with his mother Elizabeth Hoy. I had full legal and physical custody until 2000 when a Attorney and Judge came on my sons Custody case who absolutely hated me. Elizabeth Hoy who had been making false allegations since 1994 to try to get me arrested to get custody of the child back. (See 1i�:.�iibit L and 'M ,for a better understanding of the history of this cas( In 2003 1 was living in Wa. Stable and this was Stated in a Declaration written and signed '.,y Elizabeth Hoy dated 2/5/03 (EXHIBIT A ) At this time Elizabeth Hoy and hE Husband Tom 'Toy , y.,..:__.,.. were making false allegATIOns to have me arrested.At this same time Elizabeth Hoy applied for child. Suppoet in Contra Costa County where neither of us or the Child lived.On Approx,6/14/03 I was arrested in Wa State to be extradited back to California.(see Exhibit B ),I ended up in Canada where I was held from 9/03 until 11/03/2003. (Exhibit C) SEE ATTACHMENT TO CONTINUE NAMES AND ADDRESSES OF OTHER wbITNE SSGs .�lL .AdV� .1.��`�.: �li< �� .J31Vd.R245..Brentwood California,9451.$..1- 1.Q- 4�-.$�3.4...................................................... THIS COMPLAINT MAY BE SENT TO THE COMPANY COMPLAINED ABOUT, I WWN TO PILC A COMPLAINT AGAIN/T THE COMPANY NAMED ABOVE. I IINOCR/TAHD THAT THE OUTAICT ATTORNEY 16 UNADLQ TO REPRESENT PRIVATE CITIZC,II SCCNING THE IICTURN OF THEIR MONEY OR OTHER PERSONAL 1111IMEDIC6. 1 AM,HOWEVER, PILING TNII COMPLAINT TO NOTIOT THE DIATPICT ATTORN!!Y OP THE ACTIVITIES OF THIA COMPANY. Michael Davis 29 DR. COIPLAINANT'i NAME....... i ................. .......... A,1»4• ... .ii................................ 1-925-525-01388...........:.................... . Oakday..0 ,..945 .3............................... TELEPHONE HUMIENS RgIOENGE AND 6USINCIL; DAMN ......... AIDHCD C ............ .................................... DA I10 OHIYN COPY 04TNICT AYTORNCY YELLOW COPY COMPANY OR POLICE AGENCY PINK COPY COMPLAINANT Continue page 2 Fraud Complaint form CCC.DA. Special Op's I was then extradited back to Martinez Ca. (Exhibit D) and held there until 3-28-2006. That is when I was sentenced on Amended Charges(Exhibit E,read the bottom of this document) (I beat all the charges I was arraigned on) The only problem I was never formally charged with the Amended charges or arraigned on them (Exhibit F„Judge states the amended charges do not exist) I was then released on June 12 2007 (Exhibit G) . The only way I found out about the child support is my Mother received a collection notice, I later found out after my release that the State was taking my X-wife Tina Davis's tax money and Elizabeth Hoy called my mother(Margaret Davis 1-925-625-0388) about the checks and Liz knew I was in Jail. (Here is where it gets weird,the State claims to of served me through Tina in 2005,Tina never can verified she got served plus Tina was not my Legal wife at the time, I have never legally been married to Tina,just found this out,plus service to Tina was improper)Then before my release Elizabeth Hoy went to Butte County applied for a restraining order ,I never got a chance to defend myself on, I sent for a copy of the papers she filed , she lied/purged herself saying there was not an ongoing Child custody case in another County or orders,there was in Contra Costa, she stated I came to her house in 2001 and threatened to kill her and her family, yet in case#D93-00892 in Contra Costa or in the Sheriffs log this complaint does not exist, Around 12-2001 (1 believe this is accurate date) Liz Hoy tried to get a restraining order in Contra Costa which she was denied and in that application she never mentioned these threats. see Exhibits Land M where Liz Hoy has made allegations for years trying to get me arrested to keep me from my son and gain custody of the child and try to get money from my family and. stating she dreamed to separate my son and I have him for her and her husband.(all credibility issues) 1(Go to Exhibit H) Elizabeth Hoy had to fill this out to get support, neither of us lived in Contra Costa and she knew it,I have many ways to show this, she knew I was in jail and it was her responsibility to let child support know'that,but Liz had the state taking Tina's money(Who i was separated from at the time getting divorced.)(Liz Hoy then applies for support in another county,Butte (stating to Butte county i had income where Butte was charging me $300.00 a mo when I was incarcerated ,yet Butte dismissed that case)Now my contractors license is getting revoked,(Exhibit I) Contra Costa County Child support also said to pay the interest or they would take my drivers license even after they told me this was fraud, I am a victim of a crime so to deal with it I must pay or I loose my license, It does not make sense. I was told by an local Attorney, a family court clerk was circulating a picture of mine around in the court and she could not represent me,then ever single Attorney I would contact agreed to do my case but within a week they called me and told me they could not.)(Some Attorneys would call back and say they were booked, We would call that attorney later, not saying who I was or have a women call and all the sudden they were not booked, I then filed a motion to have the child support money removed due to fraud since the girl at Contra Costa County told us it was fraud, I had a court date, then went to San Francisco and hired an attorney before he had a chance to talk to anyone in Contra Costa(I Barrowed the money) Also I fear appearing in Contra Costa court due to the way I was treated in my child custody case since 2000 and my probation case, I do not want near that place,I do not want near Liz Hoy,All I want is for to quit this harassment raised 4hy child by myself for 10 years and she never gave me a dime I do not mind paying for my son, but this money was illegally and unjustly assessed (. It was also the advice from my family and friends to stay away from the court because they are afraid for me as a matter a fact I want to move from Contra Costa county ASAP.) The attorney M.Tilden Moschetti told me and the person I was with that there is no way I owe that money and that Child support places usually work with attorneys but Contra Costa County would not work with him on my support case(Exhibit J-1)A fax from Tilden to me. Then I talked to Butte County and other Counties and they all said it is the Counties duty to take that money off and address any fraud. (Child support case# F03-02552 court case# 7190460) Then my Attorney talked to the court and Contra Costa child support, he misses the court date telling me it was due to traffic. I am receiving Monthly billing statements(Exhibit J) and my family and I are afraid Contra Costa County will use this back Child support to have me arrested and/or keep me tied up in the system. I called the Sheriff's dept, to make a complaint due to this concern and others. I had an incident report made which is# C081100759 (Exhibit K for copy of that# and the officers card )Earlier in the week i called Special Op's in the D.11. office,office,the Special op's lady said they would sure pressure the child support division to take care of this.(I cannot go to family court, they did nothing but lied about me ,my family and child since 2000, How is that in the best interest of our children, Why would I go to a place where they lied and when I prove it,the Judges do nothing about it and if you complain or prove they lie, they lie to put you in.jail and I just do not know how that is about our children, and on top of that the lamiiv court clerks are passing flyers around with my picture on it which is discouraging counsel from representing me, then myfamily member tells ire alley know a court officer and she said the T A 11 1. + T 1.,,.. +. +1.. + 1 Judges all Hate lire ,>_1lave come �o lllC. reality it was planned all along my sore and 1 would suffer and not sec each other until he is 1801.) It is clear I have no riallts in Contra Costa,this was also said in my probation case. I have neverharmed that child yet he was beat and burned ,hospitalized and used as a pond by his mother to collect money, and most of all the psychological damage this has on my son and the lies he is being told. I proved in court, family and criminal these people lied over and over and if this complaint is pursued I will bet Elizabeth Hoy or some one else will start making false allegations again against me to try to have me arrested, so she is never held responsible. But if I do not pursue it Contra Costa County will arrest me for beim; a dead beat Dad for money I do not legally owe and have no way to pay, I also asked for Contra Costa to let me appear in court while I was incarcerated but Judge Berkow denied that, I had her dismissed off case# D93-00892 because my Attorney said she would rule a;ainst rne, she disliked me. Once she was removed 5 other Judges gave me gull custody of my son, I do not know how ally Tiildge 111 coiitr; ( nCfn r lii At li( _Iy dr, an :=y c___ r�17.� r.� lily events Since 210-0- 1_ Contra Costa County Child support will not assist me and from what my aLLorney said they will not work with him, I am a victim of fraud and should not have to hire an attorney when contra Costa county child support has all the proof they need to verily. 1 was incarcerated and Liz Hov applied in a county neither party lived in. Contra Costa County should of adjusted these fees months ago. Every other county in this state tells me Contra Costa should adjust the fees, as a matter of fact the girl who works at child support told Tina and 1 she would adjust the fees, she never did it. Many people involved in Contra . Costa Court have an axe to -rind with me and will not ict it p �. + VL- i WLU ud;!)4 HCl nK, wrT oju oaa o>u4 + I�L�xa :-1DRtiEY OR PARTY WRHOLJT ATTORNEY(N1'm64 a0(aDar .numaer,cne sd6rmgl: FOR COYAT ME aftr P. o. 16o)k ro�z C,1n< C 0 I C& 95Ra'7 - 10E-2_ TELEPHONE N0:5 BIZ-gggq PAX NO-- ATTORNEY O_ATTORNEY FOR(Nmn W y' j2 coe SUPERIOR COURT OF CALIFORNIA,COUNTY OF Cn`. -�o� C �L� STREET ADDRESS: 7A5 C.o�Ir�S�c MAILING ADDRESS: R 0, �]a J 9 a((1n CRYAND21PCODE: Y� J`�P L I``'`' Q`IS BRANCH NWLI 1 PETITIONERIPLAINTIFF: iM ;C via '`I t!)&W 15 RESPONDENT/DEFENDANT; ',` , 40 RESPONSIVE DECLARATION TO ORDER T HOW CAUSE CASE NUMBER: OR NOTICE OF MOTION HSAR7N0 DATE: TIME: A , A DEPARY oR RoaM D q3 1. CHILD CUSTODY a. I consent to the order requested. b. I do not convent to the order requested but t consent to tris foltowirrg order. C.O%rt-t 11 lk4 vJ 4? C. 0LX 2. CHILD VISITATION a. 1 consent to the order requested. b.� t do not consent to the order requ0Fted but I consent to the following order. 3.Q CHILD SUPPORT a. Q I consent to the order requested. b. Q I consent to guldeiine support. c. I do not consent to the order requested,but i consent to the following order. (1)Q Guidellne (2)Q Other(spec*).- 4. Q SPOUSAL SUPPORT a, Q I consent to the order requested. b. Q I do not consent to the order requested. C, 1 consent to the following order. S. Q ATTORNEY FEES AND COSTS a. Q I consent to the order requested. b. Q I do not consent to the order requested. c. Q t consent to the following order: pare~of 2 Form Adopted For aee"deron use RESPONSIVE DECLARATION TO ORDER TO SHOW CAUSE Judetel eovnou of eu,tfomfe OR NOTICE OF LOTION )LL'va[Rev.Jenuory t,-=I FNPP MyPy a"I'Yac ct—er ---- - — Page 2 of 2 CUUJ WtU Ub.,54 till rm. Kur T Diu odo 0104 r, w r PMT10NER&LA1"FF (11l L 4�1�.t �0.� � 5 c"E.NUM BER. RESPONDENT/DEFENDANT: 6. Q PROPERTY RESTRAINT • a. I consent to the order requested. b. [] 1 do not consent to the order requested. a 1 consent to the following order. 7. Q PROMFrfy CONTROL. a. I consent to the order requested.. b. .I do not consent to the order requested. C. 1 aument to the following order_ S. OTHER RELIEF a. 0 1 consent to the order requested. b. 0 I do not consent to the order requested. n, Q I consent to the following ogler. 9. suPPORTiw INFORMATioN contained In the anadred dedarathm. NOTE:To respond to a request for domestic violence restrelning ordsm requested'I 11'i r) nt for Order(Domestic Vlolenae Prevenftn)(form OV-100)you must use the Answer to Temporary Restraining Ovdar(Domestin Vk*nce Prevention)(form DV-120 1 declare under penalty of perjury under the laws of the State of Calltomle that the foregoing Is true and correct. nvm op pow xmiri JWW"7UA*of oeunnnrn) r RESPONSIVE DECLARATION TO ORDER TO SHOW CAUSE P'!V 2°'2 �sza jRw. �.2oogl OR NOTICE OF MOTION htty://www.mypyramidtracker.gov/Default.aspx?Module=21 10/25/2007 P JJV VVI) V1V'S U.J LUUJ Wt:U VU'JJ Dill JJ11, 11VJ 1 . _. Davis VS Hoy 2/5/03 ATTACHMENT RESPONSIVE(DECLARATION TO NOTICE OF MOTIOAT I, Elizabeth Hoy, mother of Michael Aaron Davis - minor, declare under penalty ofperjury as follows: RELOCATION I would bike to, first of all, offer this court and the most honorable,Judge Craddick, my most sincere and heartfelt apologies for having moved without prior approval. I assure that the move was considered in great detail. Please take into consideration that I moved my family to the East Bay Area in 1999 to be close to Mikey's father, so that we might co-parent in some way. Mr. Davis moved to Washington. M&ey successfully completed his school year, his baseball season(making the only homerun in the whole division) and his Cub Scout season. ..........._...._._.. L F Lpi.;� BOOKINGS FOR DAVIS.MiCHAEL JACK. Laef Nnate� c:+vis FlydNttttmt IfficHut OOB ® mo Nemec PACK a clr.- MAIJW CREEK EMrlhSZ�ElC CALFORhMA Nk!Nrns 18nIM�lefO0e1 ': ~---- - $Sk 'a`io-'s7-51i9J - Fes.Isr'1n30ti10. .. . :.:. A217S5311 ",... . qo •f - :C �,a. •Him • :.•b>;• Boaididb''':i'-.�RTitneed,,.e_. .` ,• :•:;:: ':;:;::.:�;;:. .,... . ......�'.. ,....,..:' _ t' 1 0W14M OR18 O GM 14.W ILONGVIBV Nifi� .... .. ...• _rte ' J - 7. 3� 1•, 1 t' h7 rl� iMv .ftft, J A: f - ol ti { .. .... .. ,t. i. p i. : c: .r. r' — Y•.' , r' �I r•' i. ..� �. �?'. •:� :•inn x. •!� � ..';y' .:t1r;. �:l�.� ,Pi"!.., :s:" .•T• ..4..r sf.e: ^�a'�� - ' •;' .:--.�: 'R4:�.; ..6: . . .... ..:�-..4;.::::' , ...:.:.. .. '1 r' r• rr i• • , ..-._..-.: :... a,.. .....-e.. •... .,.."�. �:.�.i` may.; c'. - (: i•` ar Ile �• t� b: J� �i 6 Alberta . SOLICITOR GENERAL AND PUBLIC SECURITY Correctional Services 1220085 1h street NW Phone: (403)695-2100 Calgary Remand Centre Calgary,Alberta Fax: (403)695-2079 T3R U3 DATE: April 4, 2008 TO: WHOM IT MAY CONCERN RE: NAME: Davis, Michael Jack D.O.B.: 1960/09/29 S.I.N.: N/A Please be advised that our records show the above named was incarcerated for the following period(s): Admitted to Calgary Remand Centre : 2003/11/03 Released from Calgary Remand Centre: 2003/09/26 "Crusting this is the information you require. L1-) K. Canning V A/Director Calgary Remand Centre Cc: file ------------- CONTRA COSTA DETENTION FACILITIES, Booking/Charge Report. CIN: 70053243 Book Name: DAVIS , MICHAEL , J Book#: 2003025380 Booking & Arrest Summary CIN: 70053243 Book#: 2003025380 Book Name(L,F,M,S): DAVIS, MICHAEL, JACK Book Dtffm: '11- 18-2003 2047 Release Dt/Tm: 03-2_8-2006.0213 . Release Type: STQ Warrants Check: Initial: C By:67036, COGO Dt/Tm:11-18-2003 2130 Time Served: Release: C By:41468, GARCIA Dt/Tm:03-28-2006 0212 2 yr 4 mo 9 dv 5 hr 25 mi .t G��►�� "- "-• HONORABLE BECTON SMITH E D30 PV SENTENCING MICHAEL JACK DAVIS 1 DKT# 05-020388-5 DKT #05-011410-8 zA u)G{le THE FOLLOWING PROBATION VIOLATION ALLEGATIONS WERE FOUND TO BE }Z is A� Ail 3 TRUE: 4 J 1) THE ORIGINAL PETITION DATED 2/27/2003 ALLEGING: WHEREABOUTS !S \ UNKNOWN. . L ,19 Ls �, ,�°n,) 41 r•�'+ 3tr� l. LJ»� g - •..._�_J vis �. ► C r1 A SUPPLEMENTAL,PETITION #1 DATED 3/19/03 ALLEGING: THE ANNOYING OR 7 HARASSING PHONE MESSAGES RECEIVED ON 2/26/2003 AND 3/14/2003 8 — 9 REGARDING COMPLAINTS AND VEILED THREATS TOWARDS JUDGE CRADDICK, 10 BILL ULRICH, THOMAS HOY, AND JOHN KIRBY. SQL Ca��� ---................_ -�� 3) SUPPLEMENTAL PETITION #1 DATED 3/19/2003 AL�EGING: THE ANNOYING OR 12 HARASSING PHONE CALL TO JOHN KIRBY O 3/12/2003. L t Z�1 W%-J TU . ......................._...._.._._...-_.._.. .,.r ti d:.s ..:y p..►G is Z t� 13 4) SUPPLEMENTALPETITION #1 DATED 3/19/2003 ALLEGING: THE ANNOYING OR 14 HARASSING PHONE CALL TO �U�RICH 3/14/2003. 15 5)`SUPPLEMENTAL IETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR 16 HARASSING PHONE CALL T ��ULRICH.,ON 4/16_/2003. 17 6) SUPPLEMENTAL,PETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR • 18 .� HARASSING PHONE CALL TO OHN KIRBY N 5/11/2003. 7 P `,7) SUPPLEMENTAL:PETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR 20 ---- �-- L����a HARASSING PHONE CALL TOOH'KIRBY ON /12/2003. :47 f,461 o "17j",s 21 8) SUPPLEMENTAL=PETITION #2 DATED 6/3/2003 ALLEGING: THE ANNOYING OR. 22 HARASSING PHONE CALL TO BILL ULRICH. N 5/20/2003. —24 ---r THE 6RIGINAL�LU P�EMU9AL`PETIT Q_N,5 TO REVOKE PROI,A_TIOf TATED 25 THAT THE DEFENDANT IS TO HAVE�P CONTACT WITH JOHN KIRBY OR WILLIAM � . ., .� •. .`vim ~-.•��:,�..,..�;� ' ;",�',` ULRICH, HOWEVER THIS WASdA-ME �+:TONDO NOTw�AhINQ? ;.O�f :1 •ARAS_S. THE ��4\�, - -__ _ ., i'�. `'.H."'`�•'.''Yi'!Y,nFf':._.a .. .S'YM1'x•i4. ",..-w. ...:-...n unintelligible and delusional rant against alleged racism in the judicial system and the harm-1-hli-��child�has suffered. -- On June 29, 2005 the court also received a new Faretta motion and a-mobon objecting to his probation report wherein petitioner-"is utea.cer-tain -claims in the probation report► y of the instant petition was also lodged with tho s 6-fiv-o motions. Turning-now.finally otA petitioner claims_-qO. his-'e'titi _m- M—n, peti - ----- am-to±!q2robatiob'fd The co urt has reviewed the u�n endtim:in-th6cou'rt's file, a fact 1f:6- s additional 7 were k "' flild"p""Ititig _�Eofl ion r make claims 24imes%d6d:6IFth6 violations "manufactured." se charges. Petitioner denies shooting at anyone during a child exchange. Petitioner denies harassing or annoying anyone. Petitioner further complains that the probation officer refuses to meet with him. F)nafly, petitioner requests a copy of the addendum to give to his doctor in order to obtain an accurate report." The court has read and considered the instant petition and now denies it for failure to state any legal or factual basis for relief. Vague, conclusionary' allegations will not support writ relief. (In re Swain (1949) 34 Cal.2d 300, 303 - 304.-) Th e�'csaU#zc t Ri furnish isleht!"addendUrn. Thea fition is denied. Dated: t Dan O'Malley,/ Judge of the Sup or Court cc: Petitioner 05-011410-8 Deputy DA Dominique Yancey, Esq. Maurice Moya'1, Esq. Hon. Diana Becton Smith jj/moss27t.doc 2 STA,!i:0I:CAI JI:(WNIA DI:I ART\IFN F(A (' .<f;('I[c CDC 1515 I Rev 05/01) „It \\111 I r `: I 1. If .iiv ,lint@ 12 a period of 3 years ►'his pare is subject to the following notiCe and conditions. Should you violate cunclition; of, this parole, you are subject to ares[. suspension and revocation ul'your parole. You waive extradition to the State of:California frond :lily state or territory of,the United Stites or from the DISII'Iet Of('011111111M. You will i Contest anv effort to return you to the State ufCalifornia. When the Board of Prison farts LiCICI-IlliIlC5, basCd upon psychiatric reasons. Ihat you pose a dan;er lo votirself lir others, the Board may. necessary 'rile psychiatric treatment. order your placement in it community treatment facility or State prison lir IMIV rcvukc your parole and ort your return to prison. You and your residence and anv property under Your control may be Searched without a \varr.nit by an 1went of the Department of C,Urrectlolls Or alllaw ei11,01-cement office!'. lfanother jurisdiction has lod-c(I a detainer against you,you tray he released to the.custody of that jurisdictiolt. Should you he released from th custody prior to the expiration of your Califomia parole, or should the detainer 1101 be CxCrcised, you are to immediately contact the near Department of Corrections' Parole and Community Services Division Office for instructions concerning reporting to a parole agent. You have been intin'nled and have received in writing the procedure for obtaining it Certificate of Rehabilitation(4552.21 PC,'). Cf 131 FU 11'119 NS I. SPI?CIAL CONDITIONS tiMUST: a) Relate to the cringe for which you were c(mviCtCd. b) Relate to conduct which is itseff'criminad. c)Prohibit conduct which may be related to [inure criminality. You are subject to the following special conditions: . SEE ATTACHED ADDENDUM f Reasons for the imposition ofspecial conditions of parole: SEE ATTACHED ADDENDUM (acknowledge myspecial conditions ot'parole. 4, �- PAROLIT5ENI IW-S S16N?. illi 11141I'SI!I'IiR\ . )It 1)A'r F St(ih:I;i) i�c.i.FA ii:, ice`:"0 W11 ti�li, i21.Fuiiic:�:�F', �'�"iIi i ti:� i,I.: lilileS� Vi1i(r ill rillldelllt Illi iir( illlllfUVl'.(1 111 \yrlllllg, yUll \1'111 rel1Ul'l to VC parole agent on the first working day following your release. Any change of residence Shall be reported to your parole agent in advance. Y will inform your parole agent Within 73 hours of any change of employment location.employer or termination of employment. 3. PAROLE, AGEAT [NSTRUCI'IONS: You shall comply with all instructions of your parole agent and \will mol tra\el more than 50 mi From your residence without his/her prior approval. You will not be absent from your county of residence for it period of inure than 45 hod and not leave the State of California without prior written approval of your parole a"ent. 4. CRIMINAL CONDUCT: You shall no?engage in coneluct prohibited by law (state, federal, County or municipal). You shall immiledint, infbrnl your parole agent if your are arrested feu-a felony or IllisdelnCana•Crin1C. COMIUCt prohibited by law may insult in parole 1-C\uc36 even though no criminal conviction occurs. 5. WEAPONS: You shall not own. use. have access to. of have under your control: (a) any type of firearm lir instrument lir device whirl reasonable person Would believe to he capable ofbeing used as it lircarni or:Illy arllnrtmlition which could be used in a firearm:(b)any wrap as dCfirted in state or federal statutes or listed in California Penal Code Section 12020 or anv instrument or device which a rea;onahlc pers Would believe to he capable of being used as it weapon as defined in Penal Code Section 13030. (c) any knife with it blade longer than t' inches. except kitchen knives which must he kept in your residence and knives related to your employment which may be used and carni only in Connection with your employment; or(d)a crossbow of any kind. 6. You shall sign this parole agreement containing the conditions of parole specified in Board of Prison Terms 03I1"f) Rules Sections 2512 n any special conditions imposed as specified ill 131''1' Rules Section 351 3. Penal Code Section 3060.5 provides that the f3PT Shall revoke I parole oC any prisoner!parolce who refuses to sign the Notice and Conditions of parole. You have the right to appeal the special conditions parole. SpeCial conditions unposed by the Parole and Community Services Division Illav he appealed pursuant to CidifOrlli.-t Code Regulations (CCR), Section 30;4 and 3055. Special Conditions of parole imposed by the 13PT play he appealed pursuant to CCR. Secti 2050. I have rend or have had read to me and understand time conditions of parole as they apply to tile. [M.'NUMBER PAROLFF NA:NH:(frim ur'1'S'Pe) I'ARl lt.EF S16NAI'I)Ill: ')1 F22106 JDAVIS, Michael TO BE,CO.NN9PLN:fED I31'STAFF: yuirimCffectivc cJicntiortYes `oDoes the inmate/paro)CC have a qu.ali`ying disability re ; n ? If VCs.Cite the Solu'Ce IoCunlCnt and/or observations: What type ol'acconurlodation/asistmnco was provided to achiCVC eff'Cctive.ConulunliCation to the hest of the 1nnliltc7s/parolee's ability? 1;I'AFFNAME IPrint ur'P.palSCA 51 i! , JRF 0A, ESIUrrlia T. obb, Lo. Q>� CONTRA COSTA COUNTY Department of Child Support Services • Supporting Linda M. Dippel, Director California's Children 50 Douglas Drive, Suite 100 Martinez, California 94553-8507 Phone: (925) 957-7300 FAX: (925) 335-3636 NONCUSTODIAL PARENT: APPLICANT'S PHONE NUMBER: Enclosed you will find the necessary forms to open a support case with the DEPARTMENT OF CHILD SUPPORT SERVICES Before you begin, please read the enclosed Child Support Information Handbook and the Child Support Enforcement .Program Notice. They explain the services. available and your responsibility to the Department of . Child Support Services and the Department of Child Support Services' responsibility to you. WHEN YOUR APPLICATION IS COMPLETE Mail the package to: or Drop it by the office. at: DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE, SUITE 100 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ, CA 94553 MARTINEZ, CA 94553 If you have questions, the number to call is (866) 244-5382 2404/MAY 05 STA.E OF CALIFgRNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES CHILD SUPPORT SERVICES PROGRAM NOTICE WHAT CHILD SUPPORT CAN DO FOR YOU: All children have the right to be supported by both parents. Any person, including a noncustodial parent, whether or not he or she receives public assistance, can apply for support services. Some of the available services are as follows: • locating the parent(s) for support enforcement purposes; • establishing paternity(legal fatherhood); • establishing a child and/or medical support (health insurance) order; • enforcing a child and/or medical support order • modifying an existing court order for child and/or medical support; • enforcing a spousal support order in conjunction with a child support order; • collecting and distributing support payments. CUSTODY AND VISITATION SERVICES ARE NOT PROVIDED .THE LOCAL CHILD SUPPORT AGENCY PROVIDES SERVICES ON BEHALF OF THE STATE OF CALIFORNIA. THEY DO NOT REPRESENT YOU AND ARE NOT YOUR ATTORNEY. BECAUSE YOU ARE NOT THEIR CLIENT, THE INFORMATION YOU PROVIDE IS NOT CONFIDENTIAL UNDER ATTORNEY/CLIENT PRIVILEGE. SOCIAL SECURITY NUMBER DISCLOSURE The information in your case may 'be discussed or given to the State, the Department of Child Support Services, other public agencies that can legally receive such information, and to the . other parent or his/her attorney to the extent required by law. The local child support agency is required, under Section 466(a)(13) .of the Social Security Act, to include in child support records the Social Security Number of any individual who is subject to a divorce decree, support order or paternity determination or acknowledgment. Social Security number information is mandatory and will be kept on file at the local child support agency to locate individuals for the purpose of establishing, modifying and enforcing child support obligations. Enrolling a child in health insurance may require the release of the child's Social Security Number and mailing address to the other parent's employer or the release of the child's Social Security Number to the other parent. COOPERATION WITH.CHILD SUPPORT When you request services, you must cooperate with the local child support agency by providing any information or documents needed to establish paternity and/or locate the other parent and to get support payments for your child. Once the services of the local child support agency have been requested, the local child support agency will determine the appropriate actions to take. All support payments must be turned over to the local child support agency. When you apply for, or receive, support services, You are responsible for promptly informing the local child support agency of any changes in circumstance or information. Some examples are: • child leaves the home; 4� telephone number or address changes (including a move to another State, County or Country); • stopping public assistance (CaIWORKs); • name change; • initiation of divorce or legal proceedings; • information regarding the noncustodial parent; • direct receipt of any child, spousal, or family support payment. CS 196 101102! CHILD SLIPPORT SERVICES PROGRAM NOTICE-P9 1 . 2404/MAY 05 MEDICAL SUPPORT AND MEDT-CAL Every child is entitled to a court order that requires one or both parents to provide health insurance if health insurance is available at reasonable cost. In general, the cost of health insurance is reasonable if it is employment-related group health insurance or other group health insurance. However, in determining reasonable cost, the court will also consider the actual cost to the parent(s) of the health insurance. The local child support agency will ask the court to establish or modify a child support order to require the parent(s) to provide' health insurance if it is available at reasonable cost. The custodial parent may also request that the local child support agency modify the child support order to include a provision for health insurance. This may affect the amount of the monthly child support obligations. If the noncustodial parent is ordered to provide health insurance coverage, the local child support agency will contact the noncustodial parent and his or her employer, if necessary, to secure health insurance for the child. After the local child support agency receives the policy information, a copy will be given to the custodial parent. Having private health insurance coverage does not prevent you from having Medi-Cal coverage. If you receive Medi-Cal and have individual or group health private coverage (including dental or vision coverage), you are required by Federal and State law to tell your county CalWORKs department, your health care provider, and/or the local child support agency. Failure to provide this information is a misdemeanor. You must report to your CalWORKs eligibility worker and/or local child support agency within ten days when your private health coverage changes or stops. You must also tell your CalWORKS eligibility worker and/or the local child support agency about any court order regarding health insurance. If you are only receiving Medi-Cal benefits, you must cooperate in establishing paternity and obtaining medical support as a condition'of continued eligibility for Medi-Cal benefits for you, unless you have filed and the County CalWORKs department has approved a claim of "good cause" (CA 51) for not cooperating. Your children will still be eligible for Medi-Cal. Also, all child support services will be given, unless you tell the local child support agency that you do not want services that are unrelated to obtaining medical support and establishing paternity. Obtaining medical support may reduce the amount of child support you receive. In cases where both parents are in the home, the local child support agency will establish paternity only. Under Federal law 142 U.S.C. Section 1396A (25)] health insurance belonging to a Medi-Cal recipient in a child or medical support enforcement case is used as follows: The service provider will bill Medi-Cal. Medi-Cal will pay the service provider. Then Medi-Cal will seek repayment from the other health coverage. You are not responsible for any insurance cost-sharing amount (co-insurance, co-payment'or deductible). unless a Medi-Cal co-payment or share of cost must be met. The provider may bill you for the service if you do not cooperate in identifying your private health insurance. If your other health insurance is a Prepaid Health Plan (PHP) or a health maintenance organization (HMO), you must use the plan facilities for regular medical care. Except for out-of-area service or emergency care, Medi-Cal will not pay for services rendered by a provider not associated with your PHP/HMO. Out-of-area services or emergency care should be billed to the PHP/HMO. FOR MORE INFORMATION ON CHILD SUPPORT SERVICES PLEASE REFER TO YOUR CHILD SUPPORT HANDBOOK NONDISCRIMINATION STATEMENT It is the policy of the State of California to ensure that all individuals are treated equally and that no person shall, on the basis of ethnic group identification, race, color, national origin, political affiliation or belief, religion, sex, age or disability be excluded from participation in, denied the benefits of any program or service, or otherwise be subjected to treatment that is different than that provided to others. Each local child support agency has a designated Civil Rights Coordinator. Any applicant/recipient who feels they have been subjected to discriminatory treatment may file a complaint of discrimination by first contacting the local child support agency's designated Civil Rights Coordinator or by writing to the California Department of Child Support Services, Attn: Human Services Section, Civil Rights Office, P.O. Box 419064, Rancho Cordova, CA 95741-9064 or telephone (916) 464-5200. CS 196(01102) CHILI)SUPPORT SERVICES PROGRAM NOTICE-Pa 3 q 2404/MAY 05 • 4 Bank page MEDICAL SUPPORT AND MEDT-CAL Every child is entitled to a court order that requires one or both parents to provide health insurance if health insurance is available at reasonable cost. In general, the cost of health insurance is reasonable if it is employment-related group health insurance or other group health insurance. However, in determining reasonable cost, the court will also consider the actual cost to the parent(s) of the health insurance. The local child support agency will ask the court to establish or modify a child support order to require the parent(s) to provide health insurance if it is available at reasonable cost. The custodial parent may also request that the local child support agency modify the child support order to include a provision for health insurance. This may affect the amount of the monthly child support obligations. If the noncustodial parent is ordered to provide health insurance coverage, the local child support agency will contact the noncustodial parent and his or her employer, if necessary, to secure health insurance for the child. After the local child support agency receives the policy information, a copy will be given to the custodial parent. Having private health insurance coverage does not prevent you from having Medi-Cal coverage. If you receive Medi-Cal and have individual or group health private coverage (including dental or vision coverage), you are required by Federal and State law to tell your county CalWORKs department, your health care provider, and/or the local child support agency. Failure to provide this information is a misdemeanor. You must report to your CalWORKs eligibility worker and/or local child support agency within ten days when your private health coverage changes or stops. You must also tell your CalWORKs eligibility worker and/or the local child support agency about any court order regarding health insurance. If you are only receiving Medi-Cal benefits, you must cooperate in establishing paternity and obtaining medical support as a condition of continued eligibility for Medi-Cal benefits for you, unless you have filed and the County CalWORKs department has approved a claim of "good cause" (CA 51) for not cooperating. Your children will still be eligible for Medi-Cal. Also, all child support services will be given, unless you tell the local child support agency that you do not want services that are unrelated to obtaining medical support and establishing paternity. Obtaining medical support may reduce the amount of child support you receive. In cases where both parents are in the home, the local child support agency will establish paternity only. Under Federal law [42 U.S.C. Section 1396A (25)] health insurance belonging to a Medi-Cal recipient in a child or medical support enforcement case is used as follows: The service provider will bill Medi-Cal. Medi-Cal will pay the service provider. Then Medi-Cal will seek repayment from the other health coverage. You are not responsible for any insurance cost-sharing amount (co-insurance, co-payment or deductible) unless a Medi-Cal co-payment or share of cost must be met. The provider may bill you for the service if you do not cooperate in identifying your private health insurance. If your other health insurance is a Prepaid Health Plan (PHP) or a health maintenance organization (HMO), you must use the plan facilities for regular medical care. Except for out-of-area service or emergency care, Medi-Cal will not pay for services rendered by a provider not associated with your PHP/HMO. Out-of-area services or emergency care should be billed to the PHP/HMO. FOR MORE INFORMATION ON CHILD SUPPORT SERVICES PLEASE REFER TO YOUR CHILD SUPPORT HANDBOOK NONDISCRIMINATION STATEMENT It is the policy of the State of California to ensure that all individuals are treated equally and that no person shall, on the basis of ethnic group identification, race, color, national origin, political affiliation or belief, religion, sex, age or disability be excluded from participation in, denied the benefits of any program or service, or otherwise be subjected to treatment that is different than that provided to others. Each local child support agency has a designated Civil Rights Coordinator. Any applicant/recipient who teels they have been subjected to discriminatory treatment may file a complaint of discrimination by first contacting the local child support agency's designated Civil Rights Coordinator or by writing to the California Department of Child Support Services, Attn: Human Services Section, Civil Rights Office, P.O. Box 419064, Rancho Cordova, CA 95741-9064 or telephone (916) 464-5200. C5 196 1011021 CHILD SUPPORT SERVICES PROGRAM NOTICE-Pg 3 2404/MAY 05 STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF CHILD SUPPORT SERVICES NONASSISTANCE APPLICATION FOR CHILD SUPPORT SERVICES DCSS 0373(06126)04; 1 AM THE: F� CUSTODIAL PARTY F-1 NONCUSTODIAL PARENT APPLICANT NAME (PERSON COMPLETING THIS FORM) NOTE: The custodial party is the person or party who has primary custody of the minor children. FACTS ABOUT CUSTODIAL PARTY OR GUARDIAN AND CHILD(REN) FULL NAME(LAST,F/RST, MIDDLE/ TELEPHONE NUMBERS BEST TIME TO BE REACHED HOME: ❑P.M.A.M. MAIDEN NAME I/FAPPROPRIATE) RELATIONSHIP TO CHILD(REN) WORK: BEST NUMBER TO BE ❑ FATHER ❑MOTHER CELL: REACHED AT NAME OF CURRENT SPOUSE ❑ OTHER(SPECIFY) OTHER(SPEC/FY) ❑HOME ❑CELL ❑WORK ❑OTHER ADDRESS/STREET, CITY, STATE AND ZIP CODE) E-MAIL ADDRESS Does the custodial party currently live with the noncustodial parent? DYES ONO (If"NO", give date and address last lived together) DATE ADDRESS (STREET, CITY, STATE AND ZIP CODE) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER STATE BIRTHDATE OR PLACE OF BIRTH' RACE PRIMARY LANGUAGE GENDER: APPROXIMATE AGE SPOKEN IN HOME ❑FEMALE ❑MALE NAME OF PRESENT EMPLOYER-IF NOT CURRENTLY WORKING, PRINT JOB TITLE OR OCCUPATION GROSS MONTHLY EARNINGS "UNEMPLOYED" HERE $ ADDRESS OF PRESENT EMPLOYER fSTREET, CITY, STATE, AND ZIP CODE) IS HEALTH INSURANCE AVAILABLE NAME AND TELEPHONE NUMBER OF A FOR CHILDREN? RELATIVE OR FRIEND DYES ONO Date and place of marriage (If never married, check "None"/ Date and place of divorce (lf no divorce, check "None") DATE OF MARRIAGE TO COUNTY STATE 13 NONE DATE OF DIVORCE COUNTY STATE ❑NONE NONCUSTODIAL PARENT If parents were NOT married, please answer questions 1-5 below. 1. Has noncustodial parent ever lived in California? . . . . . . . . . [DYES ONO If "YES", When? Where? 2. Has noncustodial parent ever worked in California?. . . . . . . . . DYES ONO If "YES", When? Where? ' 3. In which state were the child(ren) conceived? (Use number for each child listed below). . . . . . . . . . . . . . . . .Child # State Child #_ State_ Child # State 4. Was a Declaration of Paternity signed at a California hospital or agency?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYES ONO ❑DON'T KNOW If "YES", Where? 5. Was a Paternity Judgment established?. . . . . . . . . . . . . . . . DYES ONO ❑DON'T KNOW If "YES", Where? Have services been provided by another child support agency? (lf"YES",please give the date, city and state) DATES OF SERVICES CITY AND STATE WHERE SERVICES RECEIVED HAVE THE MINOR CHILDREN RECEIVED CASH AID?(WELFARE) From: To: DYES ONO Is the noncustodial parent court ordered to pay child support for the child(ren) named below? DYES ONO ❑PENDING COURT ORDER X TAMOUNTOF ORDER DATE OF ORDER COUNTY STATE -ED PER WEEK ❑PER MONTH List full names of all minor children by this noncustodial parent (if child is not yet born, write "unborn", and expected date of birth). (A separate application is required for children from another noncustodial parent) IF CHILD IS NOT YET BORN, WRITE "UNBORN"HERE EXPECTED DATE OF BIRTH FOR UNBORN CHILD(REN) NAME SEX BIRTHDATE BIRTHPLACE(CITY AND STATE) SOCIAL SECURITY CHILD(REN)LIVING WITH YOU NUMBER 1• ❑YES ❑ NO 2. ❑YES ❑ NO 3. ❑YES ❑ NO 4. ❑YES ❑ NO List full names of other minor child(ren) NOT related to this noncustodial parent NAME BIRTHDATE CHILD(REN)LIVING WITH YOU ❑YES ❑ NO ❑YES ❑ NO COMMENTS (Please attach a separate sheet if you need additional space) Mate of California - Health and Human Services Agency Department of Child Support Services REQUEST FOR SUPPORT SERVICES INSTRUCTIONS: Read carefully before signing each of the areas below. Your signature is required in order for us to open a case for you. I request the services of the local child support agency to assist in my efforts to locate the noncustodial parent, establish paternity and/or secure support for the children listed in Section II. I am applying for these services under the Child Support Enforcement Program under Title.IV-D of the Social Security Act. I will notify the Local Child Support Agency immediately of any of the following events: When each child marries, reaches age 19 or reaches age 18 and is not a full-time student, whichever occurs first. - Any change in my residence address, mailing address, or telephone number. Any change in my employer, including name, address and telephone number. - 'Any change in my income. Any change in.the status, cost or availability of health insurance coverage. Any information regarding the whereabouts of the other parent(s). When the parent(s) move back in together with the children. - Any change in the custody of the children. - Any change in child care. / am aware that the local child support agency and the Attorney General do not represent me, the other parent, or the children who are the subject of this case. No attorney-client relationship exists between the local child support agency or the Attorney General, and myself, the other parent, or the children. No attorney-client relationship will arise if the local child support agency or the Attorney General provides the support services l have requested. I declare under penalty of perjury that I have read, understand and agree to all of the terms specified above. SIGNATURE: DATE: Your signature below acknowledges that you are aware that any amounts overpaid to you may not be deducted from future support payments sent to you unless you consent in writing at the time, which consent may be revoked at any time. However if you do not consent to repay the overpayment to the county by a deduction from future support, the local child support agency is authorized to use the collection of the last unassigned arrearage payment to repay the overpayment. SIGNATURE: DATE: CSS 2115 (02/02) 940nrnnnv n� i rcn rano Ki„ State of California - Health and Human Services Agency Department of Child Support Services HEALTH INSURANCE INFORMATION Page 1 of 2 FULL NAME/First.Middle,Last, Suf/W ❑CUSTODIAL PARTY ❑NONCUSTODIAL PARENT SECTION 1: YOUR INSURANCE Complete this section if your insurance is provided or available through your employer or a private policy maintained by you and not the other parent. Section II is about the insurance provided by the other parent. HEALTH INSURANCE Do you currently have Health Insurance coverage? ❑YES ❑NO If YES,complete the following information. HEALTH INSURANCE COMPANY INSURANCE COMPANY'S ADDRESS: Street.Apt.or Unit No. (Address where claims are mailedl City. State,Zip Code POLICY NO. PREMIUM DEDUCTION AMOUNT CHECK ONE: ❑ WEEKLY ❑BI-WEEKLY ❑ SEMI-MONTH!Y ❑MONTHLY AMOUNT PAID BY EMPLOYER AMOUNT PAID BY YOU CHECK ONE: ❑WEEKLY ❑BI-WEEKLY ❑ SEMI-MONTHLY ❑MONTHLY NAME(SI Of DEPENDENTS CURRENTLY COVERED BY HEALTH INSURANCE DEPENDENT'S POLICY NO. t. 2. 3. 4. 5. 7. 8. ❑ Check here if names&policy numbers of additional dependents covered by Health Insurance are listed on a separate sheet attached. DENTAL INSURANCE Do you currently have Dental Insurance coverage? ❑ YES ❑ NO If YES. complete the following information. DENTAL INSURANCE COMPANY INSURANCE COMPANY'S ADDRESS:,Street-Apt.or Unit No. (Address where claims are mailedl City,State,Zip Code POLICY'NO. PREMIUM DEDUCTION AMOUNTCHECK ONE: ❑ WEEKLY EJ81-WEEKLY ❑ SEMI-MONTHLY [:]MONTHLY AMOUNT PAID BY EMPLOYER AMOUNT PAID BY YOU CHECK ONE: ❑WEEKLY ❑ BI-WEEKLY ❑ SEMI-MONTHLY ❑MONTHLY NAME(S)OF DEPENDENTS CURRENTLY COVERED BY DENTAL INSURANCE DEPENDENT'S POLICY NO. i. 2. 4. 5. 6. 7. E ' ❑ Check here if names & policy numbers of additional dependents covered by Dental Insurance are listed on a separate sheet attached. CSS 21 1 1 (09/01101) 2404/MAY OF - I r'CA ('aca Nin �� State of California - Health and Human Services Agency Department of Child Support Services CHILD CARE VERIFICATION APPLICANT NAME: I am the ❑ Custodial Party ❑ Noncustodial Parent APPLICANT: Give your child care provider this form to complete. Attach any receipts or copies of canceled checks for child care that you may have. CHILD CARE PROVIDER: Compiete the appropriate section(s) for the children of the above named applicant for whom you provide child care. SECTION I: INFANT & PRE-SCHOOL CHILDREN Name of Provider/Day Care Center Address Apt. or Unit No.. City State Zip Phone ( 1 Name of Person or persons' who pay(s) you for childcare Name of the children of this parent for whom you provide care and the amount you receive. (Circle One) Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Total: $ per week/month/day I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (Signature of Child Care Provider) SECTION II: SCHOOL-AGE CHILDREN A. For child care provided during regular school sessions: Name of Provider/Day Care Center Address Apt. or Unit No. City State Zip Phone I ) Name of Person or persons who pay(s) you for childcare Name of the children of this parent for whom you provide care and the amount you receive. (Circle One) Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Child Amount $ per week/month/day Total: $ per week/month/day I declare under penalty of perjury under the laws of the State of California that the. foregoing is true and correct. Date: (Signature of Child Care Provider) CONTINUED ON REVERSE CSS 2105 (09/01/01) 2404/MAY 05 LCSA CASE NO.: State of California - Health and Human Services Agency Department of Child Support Services VISITATION VERIFICATION NAME OF PERSON COMPLETING FORM: I am the ❑ Custodial Party ❑ Noncustodial Parent Part 1. ACTUAL VISITATION BY THE NONCUSTODIAL PARENT INSTRUCTIONS: Complete the visitation history for the past 12 months by filling in the number of hours per month the noncustodial parent actually visited with the children. Example: If the last 12 months are June of 2000 through May of 2001, you will complete June through December on the left side of the chart below. You would put 2000 for the year. Then you would complete the right side of the chart with January through May and enter 2001 for the year. YEAR YEAR NO. OF HOURS NO. OF HOURS MONTH PER MONTH MONTH PER MONTH January January February February March March April April May May June June July July August August September September October October November November December December TOTAL TOTAL Part 2. SHARED CUSTODYNISITATION ARRANGEMENTS CHECK ONE: ❑ Shared Custody ❑ Visitation Only ❑ None Please describe custody/visitation arrangements: (Circle One) Visitation Hours: From (specify day of the week) at (specify time) a.m./p.m. (Circle One) To (specify day of the week) at (specify time) a.m./p.m. Overnight Visitation? ❑Yes ❑No Is this custody/visitation arrangement court-ordered? ❑Yes ❑ No I declare to the best of my knowledge and belief that the above information is true and correct. I am aware that this may be provided to the other parent for their verification and that either party may be required to provide documentation. Signature: Date: CSS 2107 'n9/p1101). 1 LCSA CASE NO.: 2404/MAY Or, CHILD SUPPORT DOMESTIC VIOLENCE NOTICE Date: AUGUST 12, 2005 Due to recent changes in federal and state law,. the child support program 'must send child support computer records to the federal government. The federal government will give the information to the courts, child support agencies, and sometimes to the other parent of your child. If you or your child is a victim of domestic violence, we will tell the federal government and they will not give out your information without a court. order. If you think that giving out your information may cause physical or emotional harm to you or your child(ren), fill out the enclosed form and return it to our office immediately. You must fill out the form completely, especially Section II. If you do not return this form to us in 30 days from the date of this letter, we will give your case information to the federal government for release to authorized persons and/or agencies. Mail the completed form to: OR Drop by our office at: DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE, SUITE 100 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ, CA 94553 MARTINEZ, CA 94553 If you or your child(ren) are not the victim of domestic violence you do not have to return this form. Please understand that your personal information is never given to the other party without a court order. The only exception is the filing of records or documents with the court in connection .with certain court proceedings. If you have questions, the number to call is (925) 957-7300 Please have your social security number ready. DEPARTMENT OF CHILD SUPPORT SERVICES Office Use Only DATE FVI PLACED: DATE RECEIVED BY THIS OFFICE PLEASE COMPLETE FORM ON REVERSE SIDE CSS 2140 (09/01/011 "CVRjyI 2404/MAY 05 FL-150 ATTORNEV OR PARTY WITHOUI ATTORNEY(Name,Stare Bar number,and address!: 0000005 FOR COURT USE ONLY 07DMC TELEPHONE NO.: E-MAIL ADDRESS/Optional): ATTORNEY FOR IName): .SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA STREET ADDRESS:751 PINE STREET MAILING ADDRESS:P.O. BOX 911 CITY AND ZIP CODE:MARTINEZ, CA 94553 BRANCH NAME:CONTRA COSTA SUPERIOR COURT PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/CLAIMANT: INCOME AND EXPENSE DECLARATION CASE NUMBER: 1. Employment /Give information on your current job or, if you're unemployed, your most recent job.) a. Employer: Attach copies b. Employer's address: of your pay c. Employer's phone number: stubs for last d. Occupation: two months here (black e. Date job started: out social f. If unemployed, date job ended: security g. I work about hours per week. numbers). h. I get paid $ gross (before taxes) per month =per week per hour. If you have more than one job, attach an 8'/2-by-ll-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1 — Other Jobs" at the top.) 2. Age and education a. My age is (specify): b. I have completed high school or the equivalent: Q Yes Q No If no, highest grade completed (specify): . c. Number of years of college.completed (specify): Q Degree(s) obtained (specify): d. Number of years of graduate school completed (specify): Degree(s) obtained (specify): e. I have: professional/occupational licenses) /specify): vocational training (specify): 3. Tax information a. Q I last filed taxes for tax year (specify year): b. My tax filing status is: Q single 0 head of household married, filing separately = married, filing jointly with (specify name): c. I file state tax returns in Q California other /specify state): d. I claim the following number of exemptions (including myself) on my taxes (specify): 4. Other party's income. I estimate the gross monthly.income (before taxes) of the other party in this case at (specify): $ This estimate is based on (explain): (If you need more space to answer any questions on this form, attach an 8'/: by-11-inch sheet of paper and write the question number before your answer.) 5. Number of pages attached: I declare under penalty of perjury under the laws of the State of California.that the information contained on all pages of this form and any attachments is true and correct. Date: fTYPE OR PRINT NAME)• (SIGNATURE OF DECLARANT) i. Page 1 of 4 Form Ju ictalCAdopted for Mandatory use INCOME AND EXPENSE DECLARATION 2100-2113, 3552,3620-3634: Judicial Council of California FL-7501Rev.January 1,20051 4050-4076,4300-4339 www.courtintn.ca.gov 1Z '>AnA11,AAV rNr PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: . OTHER PARENT/CLAIMANT: 12. The following people live with me:. How is the person Thatperson's gross Pays some of the Name Age related to me? tex:son) monthly income household expenses? a. 0 Yes No b. 0 Yes No C. Yes No d. 0 Yes No e. 0 Yes No 13. Average monthly expenses [� Estimated expenses Actual expenses Proposed needs a. Home: h. Laundry and cleaning ........................... $ (1) =Rent or mortgage ............ $ If mortgage: +. Clothes .............................................. $ (a) average principal ....$ (b) average interest.....$ 1• Education ............................................. $ (2) Real property taxes ............................• •.•••••'. $ k. Entertainment, gifts, and vacation $ (3) Homeowner's or renter's insurance (if not included above) ........................ $ I. Auto expenses and transportation $ (insurance, gas, repairs, bus, etc.) ........... M.Insurance (life, accident, etc.;do not (4) Maintenance and repair ..................... $ include auto, home, or health insurance) ... $ b. Health-care costs not paid by insurance ................................ $ n• Savings and investments ........................ $ c. Child care ........................................... $ O• Charitable contributions .............. p. Monthly payments listed in item 14 d. Groceries and household supplies ........... $ (itemize below in 14 and insert total here) $ e. Eating out ........................................... $ q• Other (specify): ............... f. Utilities (gas, electric, water, trash) ........ S r. TOTAL EXPENSES (a-q) (do not add in $ the amounts in a(1)1a)and Wl g. Telephone, cell phone, and e-mail............ $ s. Amount of expenses paid by others.......... $ 14. Installment payments and debts not listed above Paid to For Amount Balance Date of last payment S S S S S $ $ Is 15. This form does does not contain the locations of, or identifying information about, the assets and debts listed. NOTE: If the form does contain such information, you may ask the court to seal this document by completing and submitting an Ex Parte Application and Order to Seal Financial Forms (form FL-316). 16. Attorney fees (This is required if either party is requesting attorney fees.): $ a. To date I have paid my attorney this amount for fees and costs !specify): $ b. The source of this money was (specify): c. 1 still owe the following fees and costs to my attorney (specify total owedl: $ d. My attorney's hourly rate is (specify): $ I confirm this fee arrangement. Date: (TYPE OR PR:N1 NAME OF ATTORNEY) (SIGNATURE OF ATTORNEY) FE-,so iRP .January zoos' INCOME AND EXPENSE DECLARATION Paye 3 0+4 r 7n nn,nnn" n� CHILD SUPPORT A UTOMA TED INFORMA TION LINDA DIPPEL SYSTEM DIRECTOR CONTRA COSTA The Child Support Automated Information DEPARTMENT OF CHILD SUPPORT SERVICES EMW System allows you to use a touch tone phone to answer your child support questions. You can use the system to answer common questions and get information about your case such as: payment history, case balances, case _- status and enforcement actions. The system will also provide general office information such as: office location, mailing address, phone and fax numbers, office hours and services provided. The Child Support Automated Information System can be used by either parent, other. custodial parties or agencies. You can use CHILD SUPPORT the system 24 hours a day, seven days a AUTOMATED week to find out information on your case. INFORMA TION SYSTEM The Child Support Automated Information System will allow the local child support DIAL 1-866-244-5382 agency to serve more people and provide faster service to the public. To use the Child Support Automated Information System, you must use a touch tone phone. The system will greet you with a menu of available choices. Simply listen and select the menu option you want by DEPARTMENT OF CHILD SUPPORT SERVICES 50 DOUGLAS DRIVE, SUITE 100 pressing the correct button on your phone. MARTINEZ, CA 94553 You must have your social security number and participant number to access case level information. For the best results, review the information provided here and keep it handy. N } �'� Case # DEPARTMENT OF CHILD SUPPORT SERVICES FACT SHEET CHILD SUPPORT STATE HEARING PROCESS You Have A Right To A State Hearing • If the local child support agency does not respond to you within 30 days after receiving your complaint, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for a State Hearing must be made within 90 days after you complained-to the local child support agency. • If the local child support agency does respond to you within 30 days after receiving your complaint, and you are not satisfied with the local child support agency's complaint resolution or response, you have the right to request a State Hearing before an Administrative Law Judge. IMPORTANT: Your request for a State Hearing must be made within 90 days after ,you received the local child support agency's written response to your complaint. • You can request a State Hearing in writing by sending a Request for State Hearing (form SHOW) to the State Hearing Office, or you can call the State Hearing Office at 1 (866) 289-4714. • The State Hearing Office will let you know the date, time and place of your State Hearing and will provide an interpreter or disability accommodation for you at the hearing if you need one. IMPORTANT: Not all complaints can be heard at a State Hearing. State Hearings will only be granted for the following issues: • An application for child support has been denied or has not been acted upon within the required time frame. • The child support services case has been acted upon in violation of federal or state law or regulation, or Department of Child Support Services policy letter, including services for the establishment, 'modification, and enforcement of child support orders -and child support accountings. • Child support collections have not been distributed, or have been distributed or disbursed incorrectly, or the amount of child support arrears, as calculated by the local child support agency is inaccurate. • The local child support agency's decision to close a child support case. IMPORTANT: The following issues cannot be heard at a State Hearing: • Child support issues requiring a motion, order to show cause, or appeal in court. • A review of any court order for child support or child support arrears. • A court order or equivalent determination of paternity. • A court order for spousal support. • Child custody or visitation determinations • Complaints of alleged discourteous treatment by a local child support agency employee, unless such conduct resulted in a hearable action or inaction. HELPING TO MAKE IT EASIER FOR YOU Department of Child Support Services Toll-free Telephone Number 1 (866) 249-0773 nri/oil 1111111 llllllll�11111 IIIA IIIA Illi)Illi!II'�Illli IIIII IIIII II!II IIIII IIIII1111111191 • State of California - Health and Human Services Agency Department ui Child Support Services INSTRUCTIONS FOR COMPLETING THE DECLARATION OF SUPPORT PAYMENT HISTORY The reverse of this page is your declaration of the support payment history for your case. You are asked to complete a month-by-month, year-by-year breakdown of the amounts of support that were due (ordered by the court) and the amount of each payment that was made. These figures will help determine the amount of past due support owed, if any. You must complete a separate page (or pages) for child support, spousal support, family support, medical support, unreimbursed medical expenses, and other types of support not listed. DO NOT combine child support and spousal support unless your court order combines the two support payments into a "family" support order. In the.Amount Ordered column, fill in the amount of support that became due each month since your court order began. If there has been a change in your court order, make sure each month reflects the correct amount of support due. In the Amount Paid column, indicate a dollar amount of support paid in that month. If more than one payment was made in a given month, put the total dollar amount of support paid. Put the dollar amounts next to the month in which the payment was actually made, and not the month or months which those payments were intended to cover. You may attach additional sheets as necessary. Be aware that this declaration is not confidential. and may be given to the other parent in your case for review. If there is a disagreement regarding the payment history, the parties may be required to present proof of payments in the form of canceled checks, receipts, etc. Complete this Declaration neatly and correctly to make sure there is no mistake nor confusion as to the amounts of past due support owed, if-any. CSS 2109 (09/01/01) LCSA CASE NO.: 2535/ Sf�"9 T Ca® CONTRACTORS STATE LICENSE BOARD ,• 9821 Business Park Drive,Sacramento,California 95827 STATE OF CALIFORNIA Mailing Address:P.O.Box 26000,Sacramento,CA 95826 Arnold Schwarzenegger,Governor . 800-321-CSLB(2752) www.cslb.ca.gou 150-DAY NOTICE OF INTENT TO SUSPEND SSN: 556-37-5698 TO: M AND M GENERAL CONTRACTOR DATE: 02/10/2006 2981 SADDLE DR OAKLEY, CA 94561 LICENSE: 707771 BUSINESS TYPE: SOLE OWNERSHIP Dear MICHAEL JA -DAVI . The following District Attorney(s) has identified you'as a person who is out of compliance with a child or family.support judgment or order: CONTRA COSTA COUNTY LCSA DISTRICT ATTORNEY'S OFFICE CONTRA COSTA COUNTY 50 DOUGLAS DRIVE, SUITE 100 MARTINEZ CA 94553-0 Pursuant to the Family Code section 17520, effective 07/11/2006, your license will be suspended unless a release is received from the District Attorney(s) listed above. Fees already paid cannot be refunded. This suspension may not be appealed to the State (Board or Bureau). Any license suspended under this section will continue in this status until the expiration of the remaining license term, unless a release has been received from the District Attorney(s) listed above before the license expires. If you do not agree with the action to suspend your license, you should fill out the enclosed form "Notice of Request for Review", and mail it to the District Attorney(s) listed above. When the Department of Consumer Affairs receives the release from the appropriate District Attorney(s), your license will be reinstated for the remaining license term. ANY QUESTIONS SHOULD BE DIRECTED TO THE DISTRICT ATTORNEY(S) LISTED ABOVE. 1111111111111111111111111111111 oil 111111111111111111 IN 111111 r � IA I-e OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPAh FrVEN i OF CHILD Si SPP ORT SERVICES MONTHLY BILLING STATEMENT DOSS 0265(12/29/061 LCSA. CONTRA COSTA SIATEMENTDATE: 04/01/2008 PARTICIPANT ID NUM13ER: 0070000052811 MICHAEL DAVIS PAR TICIPANrNAME: MICHAEL DAVIS 2981 SADDLE DR OAKLEY CA 94561-1730 SUMMARY OF AMOUNTS OWED CASE AND COURT ORDER CURRENT AND PAST DUE PAYMENT INFORMATION ARREARS INFORMATION INFORMATION MONTHLY MONTHLY TOTAL MONTHLY TOTAL CASE PAYMENT PAYMENT PAYMENT PAYMENT DUE INTEREST PRINCIPAL INTEREST NUMBER FREQUENCY DUE FOR DUE FOR FOR CURRENT AND BALANCE BALANCE AND PRINCIPAL AND AMOUNT CURRENT PAST DUE PAST DUE SUPPORT SUPPORT SUPPORT BALANCE 0070027139-01 MON THLY/-- 50.00 50.00 5001 17 18611.00 23612..17 TOTALS 0.00 50.00 50.00 5001.17 18611.00 2.3612.17 * If there is an arrears balance and there is no court order for monthly payments toward arrears, arrears continue to be due and payable, unless and until you are notified otherwise. • Interest on past due support accrues at the legal rate. • This balance may not reflect all interest or other charges you may owc. • Support that has accrued and payments posted after the statement ending date will be reflected on your next statement. COMMENTS/SPECIAL INSTRUCTIONS: If you feel this information is not correct, please contact us at (866) 901-3212 or the address provided on the Notice Regarding Monthly Billing Statement attached(DCSS 0274). Please tear off payment coupon below and return it with your payment to ensure proper credit to your account. PAYMENT COUPON NOTE: If the total minimum payment due is automatically being deducted from your pay, you do not need to send in any additional payment. PARTICIPANT NAME: MICHAEL DAVIS ENTER AMOUNT OF REMITTANCE: PARTICIPAN I"ID NUMBER: 0070000052811 Please make CII@Cks payable to. , CALIFORNIA STATE DISBURSEMENT UNIT CALIFORNIA STATE DISBURSEMENT UNIT Please write your participant ID number PO BOX 989067 WEST SACRAMENTO CA on your check. 95798-9067 IIJ��J�LI���II�LJ�J�IJ��II����II��I���I.11nln���nell S'K'ATE OF CALIFORNIA-MEAL D I AND HUMAN SERVICES AGENCY oLF'AR I1c)ENIOF CIIII 1)SiUPPORI SERVICES MONTHLY BILLING STATEMENT - DETAIL BY CASE NUMBER DC-1:S 0215 j061161-0-1) PARTICIPANT NAME: MICHAEL DAVIS STATEMENT BEGINNING DATE: 03/01/2008, PARTICIPANT ID NUMBER: 0070000052811 STATEMENTENDING DATE:03/31/2008 PAYMENTS RECEIVED AND OTHER ADJUSTMENTS APPLIED TO: CASE INTEREST O NUMBER DATE DESCRIPTION AMOUNT CURRENT PAST DUE PAST DUE SUPPORT SUPPORT 0070027139-01 03-31-2008 INTEREST CHARGE 157.63 0.00 157.63 0.00 • Interest on past due support accrues at the legal rate. • This balance may not reflect all interest or other charges you may owe. • Support that has accrued and payments posted after the statement ending date will be reflected on your next statement. 01's1 From: tilden@moschettilaw.com To: michaelaaron@live.com Subject: RE: Davis case Date: Wed, 5 Mar 2008 15:29:28 -0800 I am working on it. It would help to talk to DCSS first, which is what I am trying to do. M. Tilden Moschetti, Esq. 633 Battery Street, Suite 640 San Francisco, CA 94111 Ph: (415) 399-0970 Email: From: michael davis [mailto:michaelaaron@live.com] Sent: Wednesday, March 05, 2008 3:21 PM To: tilden@moschettilaw.com Subject: Davis case Tilden, I was wondering if you got that case filed or dismissed yet,you told me it would ne no problem, Thankyou Michael davis Connect and share in new ways with Windows Live. Climb to the top of the charts! Play the word scramble challenge with star power. I received a letter from Child Support today april 19,2008 and I talked to a visitor at my parents house who is retired from Law enforcement after 30 years of service and I was told that it was fraud what my son's Mother Elizabeth Hoy did to get child support accessed against me, I thought it would be in my best interest to make a police report especially since Elizabeth Hoy has collected up to a couple thousand from Tina Davis and just lately Elizabeth Hoy had approk. $300 taken from my takes for what has been described as fraudulent child support claim by Elizabeth Hoy'at one time she even contacted my mother about the checks.I am afraid this county will now try to arrest me for.non payment of child support.These are the officers name and incident report. Michael Davis "SNC � ��►IOt7�5 9 RIJENELLE DANIELS Police O(Jirer Ci-['1' of 3231 14aiu Sucet OAKLIEN' Oakhw.CA94561 925 625 11855 of irc 915 111:1 8837 vnt 925 1125 1060 dispatch 925112158857 litx i' MA -LENE. SECQ=NG, Ph.D. I ' Licensed Psychologist PSY4550 47 Quail Court, Suite 212 Walnut Creek, Ca 94596 (510 ) 930-7664 PSYCI?OLOC QL EVALUAT T CN Parents : Elizabet-h Morris Birth Date: Michael Jack Davis Birth Date: Child: Michael Davis, Jr. Birth Date: 12/7/92 Case No . 93-00892 Date Report Prepared: 4/30/94 REFERRAL Parents underwent court-ordered psychological evaluation in order to assist the court in the upcoming May 31, 1994 custody hearinc. TESTS ADMINISTERED Rorschach Minnesota Multiphasic Personality_ Inventory - 2 (MMPI-2) Parenting Stress Index (PSI) Thematic apperception Test. (TAT) Individual Dates T ime Contact Michael Davis 1/24/94 2 hrs. Interview Michael Davis 1/31/94 1-1/2 hrs. Interview Michael Davis 2/07/94 2 hrs. Interview V. :., Michael Davis 2/21/94 1-1/2 hrs. Rorschach, TAT, MMPI \; Michael Davis 4/25/94 PSI, Sentence Completion Elizabeth Morris 4/01/94 '2-3/4 hrs. Interview, Rorschach Elizabeth Morris 4/15/94 3-1/4 hrs. Interview, TAT, MMP!_ Elizabeth Morris 4/25/94 1 hr. MMPI, PSI, Interview Mickie with father 1/4/94 1 ar. Family Observation Mickie (child) 4/25/94 1/2 hr. Play Observation Mickie, mother and Tom (boyfriend) 4/25/94 Llr. Family Observation Michel Davis , Jr. PsyL`hological Evaluation Page'-Two 4/30/94 In addition to the above 16-1/2 face-to-face clinical hours , I also reviewed the following documents : Complaint to Establish Parental Relationship and Requested for Order for Child Custody and Visitation (2/26/93 ; 6/17/93 ; 10/5/93) Declaration of Elizabeth Morris ( 6/16/93 ; 6/16/93 ; 6/29/93 ; 10/5/93 ; 10/5/93 ) Declaration of Judy Morris (6/16/93 and 6/29/93 ) Declaration of Kenneth Morris (6/16/93 ) Memorandum of Understanding in Mediation Proceedings (6/18/93 ) Michael Davis ' s Letter (undated) to maternal grandparents Elizabeth Morris ' s Letters (undated) to' Michael Davis 6 pictures of Elizabeth Morris after 5/9/93 Assault by Michael Davis Picture (6) of burn injuries of Michael Davis, Jr. (8/7/93) Delta Memorial Hospital EM Report (8/7/93) by Dermontt, R.N. ; Judie Whitehall, M. D. and (8/8/93) by R. Virgel, M.D. Antioch Police Report (8/7/93 ) by Officer R. Fromme Suspected Child Abuse Report (8/9%93 ) . by G. Zimmerman, M. D. Social Service Authorization for Temporary Custody-Kathleen Carrier . (8/8/93) Contra Costa County Social Service Log of Contacts (8/9/93-8/12/93) J. Kaplan, M. D. of Burn Center - Alta Bates Report (8/10/93 ) John Copeland, M. D. Letter (8/20/93) of 8/9/93 exam Declaration (8/23/93 ; 8/27/93 ) by Elizabeth Morris ."Delta Memorial Hospital and Risk Doctor Lawyers and Judge Conspire to Steal Baby for Crazy Acting Risk Doctor'.s Son" poster Elizabeth Morris Lawsuit (116945) vs Delta Memorial Hospital, etc. (9/16/93 ) alleging malpractice, conspiracy, fraud, breach of duty, libel and slander, negligence, intentional infliction of emotional distress, breach of court orders Elizabeth Morris ' s threatening letter (9/20/93) to Pete Wilson, Judge Josanna Berkow, and Contra Costa County DA Newspaper (9/4/81) clippings of marijuana raid on maternal grandparents Preliminary Hearing filed 12/11/81 on maternal grandparents charged of cultivating marijuana Kenneth and Judith Morris Declarations (1/14/85) of fire of 10/9/84 Kenneth and Judith Morris (27143) Opposition to Notice of Hearing on Demurrer to :Complaint and Notice of Impeachment Proceedings of Judges (12/4/85) Kenneth and Judith Morris Complaint (27865) for Personal Injury (7/1/86) and Amended Complaint: Rape of an American Family, Fraud and Deceit, Libel , Slander, Invasion of Privacy, Defamation, Oppression, malice 'Michael s , Jr. Psychological Evaluation ' . Page Three 4/30/94 Court Order (27239) to Compel :laint iff ' (Kenneth Georae Morris) to Furnish Security and For Stay of Proceedings (1/20/89) , findina maternal grandfat.I as "vexations litigant" Letter of Commendations ( 11/4/92 ) for Mike Davis from super',risor Newspaper articles (5/7 ; 5/8 ; 5/12 ; 5/15/93 ) on DansvilleIs investicsation of father ' s supervisor Memorandum (5/4/93.) from, Ci tv ?_ttorney to Town Manager regarding investigations of Chief Building Officer Father ' s medical reports of De_to Memorial Hospital (1987-88) Alvin Turkin, M. D. Disability Report (1/10/94) Reported tape of conversation between Michael Davis and mother's friend' Kathy (Woody) John Muir History and Physical Report by Thomas . Bell , M. D. on Michael Davis, Jr. (2/15/94 ) and Discharge Summary (2/18/94) Medical records on Michael Davis , Jr. .(10/7 to 3/29/94) Deborah Levine, Esq. (2/16/94) Letter to Gregory rebel , Esq. In addition, I consulted wit2n the following' individuals: John Kencaid, Ph. D. , father ' s therapist; John Hamel , father' s anger management therapist; Edith Rischer, Family Court Service, paternal grandmother, and Nancy Morris (mother' s sister) . STATEMENT OF THE PROBLEM Psychological evaluation was re-Guested because of the serious nature of the allegations. Mother presents father as a violent, "crazy" male who nearly killed her on previous occasions while endangering the child. Father, on the other hand, gets very agitated and reports going through "living hell" every time he has to come in contact with "those people" -- seeing them as trying to destroy his son while "baiting" him to loss control so they can put him in jail and win custody. Father was recently (2/94) sentenced to 120 days in jail or work duty for his brutal assault of mother 5/9/93 . Yet suspicion also have been raised that mother is neglecting or abusing the child. August, 1993 , Michael was picked up from mother' s care with a suspicious burn; February, 1994 , father picked up Michael from mother in such a fragile physical state that he required immediate 3-day hospitalization with oxygen and N treatment. Illegal drug and alcohol allegations as well as threats of lawsuits also complicates the picture. Temporary custody of Michael was originally given to mother June, 1993 with father granted supervised visitation; August, 1093 father was then granted physical custody with mother granted supervised visitation; joint custody was temr-crary awarded to both parents n December except for two month =eri od from February tc uav when Michael DaVs, Jr. Psychological Evaluation. Page Four 4/30/94 father had primacy physical custody. Currently father. has Michael four nights (Monday_ 6 : 00 p. m. to Friday . 4 : 00 p. m. ) wit+: mother having Michael the remaining three days . Althouch transition occurs at the police station, incidents of unnecessary screamina apparently occurred betweenthe parents, thouch somewhat decreasing in intensity lately. Mother states in her fantasy she does not see father as involved in anyway with Michael because "I 'm afraid for hien to be with that guy. " Father sometimes becomes tearful and remorseful over his assault of mother; yet other times, he goes "off the deep end" in his accusations acrainst mother, ostensively motivated by her intention to "protect" Michael . CURRENT CONCERNS Parents met November, 1991 and. separated May, 1993 when Michael was 5 months old, after a violent encounter between each other. Mother earlier had moved down from Chico to reside with father and paternal grandparents when she became aware of her pregnancy; after about four months , the couple moved into their own studio apartment, but never married. This is both parents ' first child. Father has been married 1-2 times previously; mother has not yet married, although she considered hersel.f currently engaged. Mother alleges she is "terrified" that father will still kill her, as she states he has threatened and attempted to do on several previous occasions. She states the baby is not safe with father because of his explosive temper, erratic behavior, and threatens to steal the baby. Mother believes he would hurt the baby to get back at her. She states father "was arrested for beating his ex-wife iii Colorado and 'ahem skipped bail to California" ; that he has bragged to her that he "planted bombs in cars and even shot a man;" that he "knows people who kill for money and has been involved with the Hells Angels and with big time drug dealers. ". Mother states father has been a habitual crank, crack, and steroid user. She reports catching him shooting steroid at his parents ' house March, 1993 . Mother states father' s personality is so warped and his behavior so inconsolable that paternal grandparents had him institutionalized at a mental hospital, but he escaped before treatment. She states the past year, father has "broken any order of the court ancl laughed about it behind the judge ' s back. " She is particularly upset at him for not returning possessions she believes he has taken from her. Michael vis, Jr. Psy(thological Evaluation Page Five 4/30/94 Maternal grandmother alleges father has repeatedly threatener t:, . kill and hurt her. In addition, she states paternal grandmother advised her to have their dauc:.te= "moved cut of the state, chance her social security number, chance her name and disappear. I can ' t control a deranged 32 year oic man. We are afraid for our lives . " Paternal grandfather alleges father has been "arrested on numerous occasions in different states for beating up women . . . was kicked out of high school for fighting everyday is under investigation by his former em. -clover, the City of Danville. " Based on father' s violent assault on mother May 9 , 1993 and his history, mother was granted physical custody of Mickie June 15 , 1993 while father was given supervised visitation: Less than two months later, when father picked un Mickie for his first overnight supervised visit, he noticed suspicious marks on Mickie. Father then took Mickie to numerous doctors, three at Delta Memorial Hospital (Judi Whitehall, M. D. , initial ER visit 8/7/93 ; Roger Virael , M. D. 8/8/93 ; Gene Zimmerman, M. D. exam on 8/9/93 ) , 'John Copeland, M. D. (exam on 8/9/93) , and Jerald Kaplan, M. D. at Alta Bates Burn Center on 8/10/93) . The reports generally indicated the burn non Mickie 's :foot were suggestive of neglect, if not abuse, because of the shape and deepness of the injury was inconsistent with mother' s account of .the injury of a curling iron dropping on his foot; concerns were also raised by mother' s failure to obtain immediate medical treatment (8/3/93) for the injury or to communicate anything to father about the injury when. he picked up the child from her: Mother alleges the doctors were "bought" by father and accuses father of ''doc-or shopping. " She then initiated a lawsuit (9/16/93 ) alleging malpractice, conspiracy, fraud, intentional inflection of emotional distress, breach of duty, etc. against Delta Memorial Hospital and the doctors associated there, father' s parents, the therapist and his attorney as well as Dr.. Copeland and Alta Bates Medical Center. Four days later, mother threatened to add the Governor, Judge, and DA as defendants to this suit although she later withdrew the- lawsuit.. Paternal aunt had previously stated to CPS (8/9/93) that father was trying to get another evaluation "due to possible conflict at Delta" because of paternal grandfather' s 32 years employment at Delta Memorial Hospitalas an anesthesiologist. When father told CPS (8/10/93 ) that he was going to go to Family Court for an immediate hearing to •obtain custcdv, CPS decided they had "no basis to file" since there were "no allegations against father. " Chico Police Department (8/17/19:3) subseqquently f ound no evidence of criminal neglect by mother. Based on the allegations of abuse/neglect, father was given chvsical cus,-odv August 30 , 1993 Michael;i }vis , Jz Psychollcal Evaluation Page Six 4/30/94 with mother granted supervised visitation. in December, 1993 , the temporary order for joint custody was established as well as an attorney appointed to protect the interest of the child and help mediate between the couple. Somewhat later, , an additional allegation arose .that mother was neglecting Mick-;:_e because he had to be hosmitalized after bei ncf _nicked from her care. Apparently 2- 3 weeks later Amoxicillin was prescribed. for "tonsillitis and a slightly red ear. " Dr. Bell noticed that when he examined Mickie 2/10/94 , t'Zat he was considered improved although he clinically demonstrated continuing sign of otis media so Dr. Bell changed the medication to Septra. In addition to concerns of Mickie ' s safety, father raises issues that mother may be abusing drugs or alcohol , that she raise Mickie to be a "loser" like her parents, and to develop poor morals by telling him to lie, to leach from the system or file false lawsuits for personal gains. He te.ports that maternal grandfather was found a "vexatious litigant (1/27/. 89) , that maternal grandmother was arrested (11/19/84.) on charges of setting a fire to some of her possessions in order to buy new furniture for moving into their new home; that maternal grandparents attempted ,(12/85) to start impeachment proceeding against judges , and that maternal grandparents were charged 12/81 with cultivating marijuana in their backyard. He states that maternal 'grandmother perjured herself in court by stating 6/16/93 "The only drug I have ever taking are prescription drugs. " A friend of mother since 6th , grade (Kathy Woody) has stated to father that she used to do drugs frequently with mother (e.g. coke) that maternal grandparents regularly bought drugs from her ex-boyfriend; and that she .got "loaded" with mother as well as maternal grandmother. FATHER' S HISTORY AND EVALUATION Father comes from an intact family with three sisters. His parents are currently retired with father prematurely forced to step down earlier than he had anticipated because of nine triple by-pass heart surgeries. He general describes his parents as religious , hard-working people. He states his father did not have time for friends growing up and that he worked his way through school to become an anesthesiologist while taking care of his sibling. His .mother was a nurse. His; mother worked full time while he was growing up and his father was working 12-15 hours a day. Father and grandmother report that although Mike had been ,an A and B student up to tte 8th grade, they increasingly had difficulty with his adolescent rebellion. Father always felt, and grandmother conf;rned, that he was not .living up to their expectations -- that " ,Michael D-y Jr: \ �` C�, 'Psychologida.l Evaluation Page Seven . 4/3-0/94 he was lectured from his father "You 're never acing to be nct.ting your life is wasted, " because his goal in li_e has been to be a baseball player instead of a professional which his parents wanted.. At aged 14-15 , he smoked. marijuana, stated that his attitude went "to hell , " his grades dropped to D' s and F ' s, that he started hanging around different sets (drug friends) , and dropping out athletic activities _ His parents became concerned acout the situation, "tricked" him into getting admitted into a one week psychiatric evaluation at McCauley Clinic when he was 15 years old. After completion of the evaluation, father moved in with paternal aunt and uncle for a year. He responded well to his relatives "respect, " "limit and responsibility" ; his grades went back up to Bs ; he regularly helped out his relatives on the ranch, got a job and bought himself a car. He then returned home to finish high school. At aged 19 , father was married for a year when the girl he was involved with becamepregnant; although she had a miscarriage three weeks before lChe wedding, and father stated he wanted "out, " he went ahead because he did not want to hurt the girl 's feelings or disappoint his aunt and uncle. Father describes his relationship with his father as improved as he has got older since he sees his father as more open-minded and better able to relate to him. Yet he still feels put down by father, even in areas he knows his parents feel proud of him (e.g. athletic abilities ; his parenting of Mickie where he has been told he "puts women to shame") ; father . states a compliment from his dad goes something like "I didn't think you could do it, but you're better than I thought. " He also described father as someone who has had trouble handling pressure and that he frequently screams and flies off the handle at home while his mother works to keep peace. Father denies being a violent person, but sees his anger problem as caused by letting things . build up inside until he explodes. He reports first getting into trouble with his anger when he was 17-18 and he beat up another kid for pushing his sister. He believes he was responding at that time to peer pressure - that he would be looked down upon if he did not do something to protect his "little" sister. Charges were pressed at the time, he pleaded guilty, and he was put on probation for si.x months to a year. When he was 23 years old, father reports his driver's license was suspended for a while because he had Itoo many tickets (e.g. stop and go, speeding, etc. ) . During another period in father' s life he described himself as having anger management problems. These occurred eight years ago when he was on steroids and he felt pumped -up with "steroid race" and ccnstantly on edge (e.g. he could not help tolerate standing in long _-ne; He was 25 years old at the time when he. became f Davis , Jr. Psycholonal Evaluation Page EightiJ 4/30/94 involved in a turbulent, abusive relationshia with a 37 year old woman he alleges was on drugs . Police were involved on a couple of occasions when he allegedly beat up the woman and hi` a guy he states pulled out a gun on him. Father believes this woman told the police one thing, yet something else to him. For instance he described her coming over to his house when she had a restraining order against him, having sex and telling him she would drop the charges if he would marry her. He reportedly did to go to Las Vegas and got married although he says he filed for false information so he believes he is not legally married. The relationship reportedly lasted five months and he has not seen her since.. He believes he has put himself in a lot of bad relationship in the cast. After getting out of this relationship, father reports trying to straighten up, get off the steroids, and go back to school to try to make something of himself. He met Liz while finishing school , then moved to Danville to accent a job as a building inspector. Father' s relationship with mother also reveals major anger control problems. At times father seems to be beginning to take responsibility for his assault. Thus he immediately went into therapy, attended anger management classes, and showed some remorse for what he did to mother. He feels in the long run "this might be the best thing that happened to me. " Yet, it still does not take much to provoke father, at least verbally, or put him in the state where "he is embarrassed about having associated with such low life people, " or overly agitated about the situation. Father attributes his assault on mother in part to the stress he was under at the time. In addition to mourning the loss of his uncle' s death, father was feeling a lot of stress in his employment as a building inspector for the City of Danville. He was doing a lot of overtime work (at times 130 hours every two week) and asked to do illegal things for his boss. Things started heating up when a new employer started to go to the DA with his boss. Father then felt "caught in the middle" as the DA interviewed him (first week of May, 1993) and he experienced the City Attorney and management trying to get him to cover up. When he testified against the City, he was told that week that his job was over although his boss was subsequently indited and father received a settlement from the City of Danville. In any case, later that week Friday, May 7th, he felt exhausted and fell asleep at the wheel, woke up when he taken by an ambulance to the hospital, after running into a tree. The following Sunday, on Mother' s Day, he assaulted mother and lost his son. A couple days later his father was hospitalized for another emergency surgery and he felt his life was torn apart. He sees his therapy as helping him put back the pieces. �v .��c:nael D vis,Jr. psychologl Evaluation • Page Nine 4/30/94 Father reports his drug history consists of smaking "pat" one year when he was 14-15 .Years old. He states he tried cocaine one time when he was 20-23 but he did not like it but then became addicted for about a year to steroids (under doctor supervision) when he was 25 years old. Father described himself as a very competitive man particularly in athletic activities . He denied- ever' sellirg drsgs and being involved with the Hells Angels ; he appears to drink alcohol minimally. Father has been out on disability although he has started going back to work (against doctor' s recommendation because he cannot stand to stay at home "mauling over things" ) . He sees his energy as equally divided between his son and work, with little left over for social or dating experiences . He reportedly -broke off one relationship because the woman did not meet his parenting standards. He states he has always wanted children, volunteered time babysitting relatives ' children, served as a coach of - little league teams, etc. or has donated time or money to children' s charity events . On interview and testing, . father comes across as a highly intent but rigid, naive male who often seemed to lack social awareness of how he comes across. He is outgoing, enjoys social contacts, but is overly depended on others for feedback; directions, and affirmations of his . personal worth. At times there is a macho, competitive quality to him and he comes across as intolerant and crude. Although he shows some introspections, there are large gaps in his insight. He has a distorted notion of himself and others, and he can be defensive about acknowledging psychological problems. Although apparently bright enough, serious distortions and problems were seen in his thinking, judgment, and decision making: On occasion, his emotions can take over, especially when dealing with his relationship with his father or authority issues. He then can get so agitated or flooded with rage to the point he has to work hard to maintain reality and control. Yet capacity for control was greater than I had anticipated from his. history -- probably because of his therapy and anger management classes. Yet his behavior and thought process are still unduly influenced by his early emotional struggles and continuing need to reassure himself that he is adequate. He is overly invested in protecting his son, but does show a stronger capacity to connect to people than mother, a drive or ambition to better himself, and a capacity to become involved with therapy and make some changes. I did not see evidence of an addictive personality or conduct disorder with -father even though father has demonstrated a history of some serious assaultive acts: michael D..:v1S, Jr. `Psycholocal Evaluation : Page Ten 4/3.0/94 TM�OT'r?E� ' S HISTORY AND EVALUATION Mother has an older 32 year old brother from her mother ' s first marriage and two siblings, a 14 year old brother and a 19 year old : sister frcm mother' s second. Her parents divorced when her mother was three mcnth pregnant with her. Subsequently her mother did not want to have anything to do with her father so she never got to know him. Mother states her father was "never a part of my life, " because her step-father was there. Mother reports that her mother has not been working in the past year and that her step-father is currently on disability for his back injury. He has been working the past three years as a used car salesman. After serving time in Vietnam step-father reportedly graduated from college with a degree in religion which he does not use. Stem-father also initiated a lot of lawsuits for himself and others as a paralegal . Although mother reports begin embarrassed sometimes of his legal suits , she apparently relied on his help and support last September in filing her lawsuit against everyone she perceived as supporting father' s position that Michael" s burn looks like abuse or neglect. Although mother states that she later dropped the lawsuit on advice of her family court attorney, she continued to feel justified in suing because she saw herself as unfairly treated and "felt victimized ' by the system" because "it was like somebody kidnapped my baby. " Aside from mother' s limited contact with her father and her older brother' whom she described as a "rebel , " mother described her family as very close. Mother described her mother as one of her best friend, someone she calls one to two times a day, who is a good parent for her because "she always tries to get me whatever I wanted" (e.g. a pony for her when she was 7, a horse when she was 12) . She was reportedly la when her parents were busted for marijuana and her parents lost their catering business. Mother reports money then became a problem for them, but she recalls little =emotional impact otherwise on her. She reports always getting good grades in school with little effort. After graduation from high school, it was hard for her to decide what to do. For a year she worked as a horse groomer at a ranch, then worked 2-1/2 years as a cashier, with last 3-1/2 years as a waitress. Mother states she has been on disability since last May when father beat her up. She decided to go back to school with a goal now of becoming a teacher. She isi.taking classes on Tuesday and Thursday from 8 : 00 a.m. to 5 : 30 p.m. She anticipates continuing at this rate until she has her AA degree from Butt Cc Ilege in June, 1995, then intends to trans-fer to Chico State to complere her certificate. She will have to cc back. to -wcrt in Jure when her Michael LQ s , Jr. Psychological Evaluation Page Eleven 4/30/94 disability runs cut or apply for a student loan. She wants her teaching credential as soon as possible. Mother denies using any drugs except for marijuana about 9—_o tines when she was 15-16 years old. She states she has no respect for people who spent time or money on drugs although she acknowledged her parents and : friends use drugs regularly. She also denies having any alcohol problem although she acknowledged heing arrested twice for BUI ; one arrest occurred in 1992 when she was "set up" by father and cne time in 1988 . She also acknowledged she was. arrested when she was 18 years old for petty thief. Mother reports that she has always wanted to have a family with twokids , a nice house and to be "in love with a gcod man" and have lots of animals around. Her stated philosophy of c:'7ild rearing is "fun is important - to keen a happy outlook. Education is imoortant; as a kid I like to read. It is important to use your =maginaticn. It is important to have social ties , like cub scout; to be involved with church. " Currently mother is residing in a two bedroom apary�ment in a government subsidized housing unit with her 19 vear old sister and her boyfriend Tom. Mother reports that Mickie sleeps it their bedroom in his own crib. She remorts that her and Tom have been together seven months and described their relationship as one that she has always dreamed about, but no recognition that she has previously described her relationship with father in a similar way. Mother states that she intents to be married by June, 1995 to Tom. Mother reports having lots of concerns about Mickie now. She states he has beensick and on antibiotic all winter whereas he was never sick when he was with her. Although she states that father "was fine with the baby when we were together, " she now raises suspicions he is teaching Mickie to "beat up others. " She noted when she dropped him off one time at Day Care, he went up to another child and grabbed and bit him. She believes Mickie throws his food and laughs because father is teaching him to do these things. However, in myfamily observation sessions, mother was noted to frequently sit back passively when Mickie threw tinker toys around the office or smile at him while verbally telling him to stop without making any physical intervention. rather was noted to be more effective about intem-zening with sitting limits around throwing things. Mother reports also being concerned that -father only feeds him junkfood', states that she has a hard time getting Mick e to sleep at nicht by her=_e1=, and wer__es that father wi11 not take good care cf Mickie ' =_ teeth lar—a cn or read .tc -a'-m Michae r vis, Jr. Psycho i7ical Evaluation Page Twelve 4/30/94 everyday. Mother states thoroughly enjoying Micke, descri:^ing their time together like a holiday. Although superficially mother presents a good facade, her passivi t in interacting with Mickie, her failure to obtain medical treatment for Mickie, some inconsistencies in her reporms regarding abuse charges, the distortions in perceptions and thought processes are disturbing. The TAT revealed serious problems with thinking, perceptions, judgment, and decision making. closer inspection of mother' s psychological testing reveals a narcissistic-core in mother where she is focused predominantly on getting pleasure including sexual gratification, almost addictively. For example, . on the sentence completion, she responded to the sentence "The thing I want most of all is" with "have fun" ; or "When I thought of growing up and getting married" with '"I wanted to be in love forever. " When she is not st_mulated or forced to deal with more routine, mundane tasks, mother seems to zone out (i. e. potentially leaving Mickie unprotected) . Her relationship with a male takes on primary importance to her. One has the sense, in spite of what she says verbally, the child is f_equently an extension of her, coming second in importance. Having fun, being narcissistically gratified seem more important to. her. Thus she has difficulty putting herself out for . someone else or - seeing things from their perspective. In addition, mother' s projectives revealed problems in relating closely to others. She also appears to have quite a bit of ambivalence about being a parent. She seems more identified with the child who wants to play at being a mother for awhile, then run outside to play herself while someone else is at home taking care of her physical needs. For instance in one TAT card, the central character hands the baby back to her mother and "runs outside to play"; on the blank TAT card, mother projected a fantasy around two fairies floating out to play together while their mother stays behind- "waiting for them, cooking dinner. " Mother's response to the Parenting Stress Index also raises some concern. Whereas mother rated herself positively on most parental characteristics , she rated Mickie notably more negatively on child characteristics. In fact, the significant validation on the Adaptability. Scale (90%) in conjunction with the high score (80%) on "Reinforces Parent" raises strong possibilities that mother is feeling . a lot of unacknowledged frustration in her relationship with Mickie. Mickie is an active, energetic child (like father) with a strong mind of his own who is likely to need an active involved parenting style. Mcther for the mcst part however appears unaware of these issues. Michaelavis , Jr. Psychol al Evaluation Fuge Thirteen 4/30/94 Although some of. mother' s and maternal grandparents ' al orations may be manipulative, for the most part mother appears unaware of her lack of integration. She has the public facade of prccerness , but she has not looked at her inner narcissistic core and addictive style. This narcissistic personal characterological pattern results in passivity and a lack of awareness of Mickie ' s heels at . times, possibly putting him at risk. SUM141ARY AND RECOMMENDATIONS Although both parents described themselves as "excellent" parents and demonstrate some caring for Mickie, each also possesses a lot of distortions in perceptions and thinking as well- as liabilities in being Mickie ' s primary caretaker. Father appears more connected and emotionally invested in Mickie (going overboard sometimes) whereas mother' s narcissistic character structure blinds her to some of Mickie ' s needs which could result in neglect. On a behavioral level , mother is more even-tempered and easier to deal with than father whereas father has demonstrated disturbing assaultive behavior when under high stress or steroid medication. Yet mother looks like she may be more frustrated by Mickie, increasing some risk for Mickie of being abused. Thus it appears to be in Mickie ' s best interest 'Co continue with the current joint custody arrangement until he starts school. To date, Mickie appears to be a happy, adaptable child who has accommodated to the transition between two warring conflictual parents. Behaviorally, Mickie appears to prefer males ( father or boyfriend) although he is also attached to mother. : Thus , the custody arrangement should foster Mickie ' s attachment to both. parents. To each parent ' s strong credit, neither parent has objected to me about the weekly six-hour roundtrip entailed in picking up Mickie, although each has been stressed by their confrontation with the other. Based on the high intensity and animosity between the parents , it is strongly recommended that a Special Master be appointed to deal with parents ' problems in working together conjointly. Mother continues to wish father has no contact with Mickie. Father, on the other hand, occasionally expresses desire to coparent with mother, but then gets carried away in verbal tirade against her. Michael Des , Jr. v ' . a \.:'.y Psychological Evaluation ; Page Fourteen 4/30/94 The following specific recommendations are as follows : 1. Father continues to have prvsical custody of Mickile Monday 6 : 00 p.m. to Friday 4 : 00 C .M. ; mother to have custody_ Friday 4 : 00 p. m. to Monday 6 : 00 p .m. 2 . The exchanges will -continue to occur at t1ne cclice station at the receiving parent ' s lec-=1'ty. 3 . Holidays are to be alternated between parents, but mother granted Mother' s Day and father granted Father ' s Day. 4 . Father should be ordered to remain in individual psychotherapy. 5 . A Special Master should be 'appointment to settle conflict between the parents, including transition issues and allegations against each . cther. 6 . Random drug testing to be obtained on mother. 7 . Both parents shall refrain __cm making negative comments about each other in the presence cf- the child. MARLENE BECKING, Ph.D. Licensed Psychologist PSY4550 4• PETITIONER'S vp _ E7t;HItRIT MARLENE I SICKING, I'll.]). Licensed Psychologist P.SY4550 S47 Quail Court, Suitc 212. Walnut Crcck, CA 94596 �t 3' (510) 930-7664 011I,I) CUSTODY RE-F,VALUATION Name Relationship Mirth Date: At!c Michael Davis Father 09/29/60 35. Elirabcth Iloy Mother 05/25/66 30 "Mikey" Davis Child 12/07/92 3-s Case No. D93-00892 Datc Report Prepared: 8/11/96 REF1?IZRAL Mikey and Iris parents were relcrrcd for "court-ordered" rc-evaluation. PSYCITOLOGICAL 'T'E'STS UTILIZED Rorschach Inkblot Tcst Thematic Apperception Tcst (TAT) Sentence-Complcticin (S-C) Minnesota Multiphasic Personality Inventory - 11 (MMPI-2) Millon Clinical Multiam"ll. Invenlory _ III (MCMI-III) SCAT?-IDU E OP PROCEDURES Names Dates Timc Contact Michael 05/29/95 1 hr. Interview Michael 04/2',)/96 2 ht's. Interview Michael 07126/96 2 hrs. Rorschach, TAT, S-C Michael n-70010f MMPI-2: MCMI-111 Michael Interview Michael Interview Davis Family Child Custody Re-llValmatlon I'age 2 8/11/96 Names Dates Time Contact Elizabeth 06/02/95 1 hr. Interview I.dizabeth 06/28/96 2 hrs. Interview Elizabeth 07/05/96 2 hrs. Rorschach, TAT, S-C Elizabeth 07126/96 '/ hr:A- Interview, MMPI-2 E /a Elizabeth 08!07/96 1 ' liras.+ Interview, MC.N41-111 Mikey 07/19/96 1/3 hr. Structured flay Observation Mikey 07/26/96 1 hr. Structured Play Observalion Mikey 07/29/96 1 hr. Structured Play Observalion Mikey 08/07/96 1 hr. Structured Play Observation Mikey 08/09/96 '/z hr. Structured Play Observ�rlion Mikey-Cousin Jake 07/19/96 '/i hr. Play Observation Tina-F.,.her's girlfriend 04/29/96 '/2 hr. Interview Thomas Hoy (grandfather) 05/03/96 1 hr. Interview FAMILY OBSERVATIONS ANI) TRANSI'T'IONS Mothcr/Tom, Mikey 06/02/95 1 hr. Family Ohscrvalforr, goodhye to father Fatl-,cr/Mel issa. Mikey 05/29/95 1 hr. Family Obscrvalion Jesse, Mallory Mother/Tom, Mikey, 05/03/96 1 hr. Fancily Observation, goodbye to room Ibiley Father, Mikey 05/03/96 '/i hr. Observation of transition to father Father. Mikey 05/10/96 '/z hr. Family Observation, goodbye to dad Mather, Mikey 0.5/10/96 10 mins. "Transition to mother Mother, Mikey, Bailey 05/17/96 '/z hr. Fainfly Olmervalion, goodbye to mom Father, Mikey 05/17/96 '/i hr. Transition to father ' llavi:; Fancily Child Custody Re-lvalualion Page 3 8/11/96 Nantes Dates Time Contact Mother, Mikey, Bailey 06/28/96 '/z hr. family Observation, goodhye to nmna Father, Mikey 06/28/96 10 mins. Transition to father Father, Mikey 08/09/96 '/z hr. Transition to father Generally then, Mikey was observed 3 hrs. 10 minutes with each parent and/or extended family. On 2 observations (6/2/95; 5/10/96) totalling I hour 10 minutes, Mikey was oh.wrvcd dropped off by father to he with mother. Four appointments (5/3/96; 5/17/96; 6/28/96; S/9/90 for a total of I hr. 40 minutes) consisted of sessions when Mikey was observed going from mother's custody to tether. In adcr'tion to the scheduled ;appointments, i consulted with the l'ollowing individuals: Lisa .Salyman, Butte County CPS; Chico Children's Center, Mikcy's medical care I';acility. in Chien; Charles Craig and Gayle Shiftman, father's probation officers; Jahn Kincaid, ['h.l)., father's therapist; Ur. Fric:son, Mikey's pediatrician in Antioch; Shannon, Director •.,I' Learn and Play. Mikey's preschool (5/1/94 - 7/6/95); Janic, day care for Mikey (5/94 - 8/04, 4/96 - 8/96); Chet I3ollard, father's employer; Stacey Anderson, Contra Costa County CI'S and personal reference for father. i also spoke with Mrs. Peggy Davis, paternal grandmother; Jennifer Young and 'Theresa Jones, father's sisters; Mrs. Paula Davis, paternal aunt in Salinas; falher's current and previOus girlfriends, Tina, Melissa and Kathryn; Mrs. Judy Morris, maternal grandmollicr; Caroline Uanderpool, stepfalher's mother; Sybil, pastc:r's wife of the church mother attcnds with Mikity; Anna, mother's friend; Annette Wolfe, mother's friend; Rose f;lumakall, mother's friend. i have also reviewed the following documents: • My original psychological evaluation (5/11/94) and letter (1J27/95) tit i'aula Lorc;ntzer • Court Order regarding Custody, Visitation, R/O and Results of 'Trial - Paul L.orentzer • Court Order (6/6/95) re Custody, Visitation, Support • Court Order (5/l/96) Denying Motion to Remove Counsel for Minor and I`urthcr Orders • Contra Costa County Superior Court, Full Case history of D93-00802 (5/31/1)( -4/4/96) Contra Costa County Superior Court, Case History of 94.01954 (7/5/94 .. 2/27/9(1) • Contra Costa County Detention Facility - History of inmate - 12/23/94 • Contra Costa County Sheriff's Department Report - 5/10/93 • !Cathryn Sizemore (6/21/88) Order to Show Cause and TRO on Michael Davis r 1 `Davis Family Child Cusfody Re-I�valuation Page 4 8/11/96 • Kimberly Davis (5/3/91) Order to Show Cause and TRO • 'ferri Bruno (3/18/96) Order to Show Cause and TRO on Michael Davis • Terri Brw10 (5/12/95) Order to Show Cause and TIZO on Michael Davis • Terri Bruno (4/12/95) Order to Show Cause and TRO on Michael Davis • Michael Davis (4/15/85) Order to Show Cause and TRO on Terri Bruno • Michael Davis (2/24/94) Withdrawn Not Guilty flea - Order fOr Probation Probation Officer's Report and Reconw-mndations (6/5/96) • Court Order- (6/11/96) Dismissing inforrrration and Deeming Offense Misdemeanor • Antioch Police Report (1/12/95, 1/3/95) by Liz Morris Hoy • Chico Police Report (5/2/95) regarding Alleged TRO Violation and Threatening Telephone Call (7/10/95) to Tom ploy • Walnut Creek Police Report (7/11/95) regarding alleged threatening telephone calls to Michael William Davis, Esq. • Monterey County Sheriff's Department Crime Report regarding alleged child abuse (4/21/96) • Letter (8/17/93) frons Elizabeth Morris--lloy to father's employer, City of Danville • Declarations of Gregory Abet (5/3/95;6/2/95) • Declaration of Judy Morris (6/2/95) • Declaration orrina Borris (1/21/96) • Declar'alion of William Davis (6/1/95) • Declaration of Tom lloy (4/3/96) • Declaration` of' I lizabeth Morris-Iloy (8/27/93; 6/6/95; 4/3/96) • Order to Show Curse and Declaration for Contempt (2/13/96) • Responsive Declaration to Order to Show Cause (4/23/96) and Declar.,.rtiun Of Michael Davis • Motion I'or Modification of Custody, Visitation (7/8/90) • Chico Police Report (7/24/93) by Elizabeth Morris, Memorandum of Points and Authorities in Support of Motion for Order Requiring Plaintiff to Furnish Security (11/20/92) - Mr. and Mrs. Morris lawsuit against Netco foods, Inc. • Award oi' Arbitrator (3/16195) • Complaint (C94-01954) - Property Damage, 'Personal Injury, Assault and flattery, Conversion, Harassment - 5/6/94 • Request for Admission - Set I to Michael Davis • Answer (Michael Davis) to Interrogatories - Set I • Request for Admission - Set I to Elizabeth Morris • Response (hlizaheth Morris) to Request for Admission - Set I • Response to Admission and to Interrogatories by Elizabeth Hoy • issue/Settlement Conference Statement - 4/14/95 • Notice of Amount of General Damages Being Sought (4/26/95) 'Davis Family Child Custody Rc-f.valuation Page 5 8/11/96 • Log of Occurrences Where Michael Davis 'Threatened Elizaheth I loy and/or family' • Declaration of Kenneth Morris (6/2/95) • Memorandum of Points and Authorities on Opposition to Defendant's Molion to Set Aside Dcfault Judgment (7./20/95) • San Ramon Regional Medical Center Report (5/10/93) • Letter (1/10/94) to Mr. President, Attorney Gcneral Janet Rend, .lodge Minney and I'M Office by Mr. and Mrs. Morris • Letter (5/4/94) to Judge Flier from Mr. and Mrs. Davis • Petition for Writ of' Mandate • Judgment Aftcr "Trial - 7/.18/96 • Notice of Intention to Move for it new Trial (7/21/96) • Transcript of Videotaped Proceedings - Order After Ilearing - 5/18/95 • Letters ( 12/5/94; 7/25/96) form Butte County DA to Michael Davis • food Stamp Information - Medical Eligibility of Mikey Davis •, BURe College Academic Transcript of ['11 .abeth Iloy (fall, I9R5 - 1988. 1.992, 1994- 1995) "Transcript From Chico State for Elizabeth ploy fall, 1995 • Transcript from Butte College (1992-1995) for Tom ffoy • Michael's schedule with father • Reference Lcttcr (6/27/96) from Mari [Innis-Applegate: for laizabcth Ifoy • Lcttcr (4/17/96) from Leonard Schmitt, DDS • Letler (10/14/94) ,froth Richard Cahoon, Ph.D. • School pocket from Mikcy's current Preschool Chico Mother's Club Newsletter 7/96 • Solar Swire and Gym - Swimming Skills Test on Mikey • f lomc video by mother with Mikey at Chico and maternal gr;uullzarents • biome video by father of his residence • Mikey's baby food Various pictures of Mikey STATEMENT OF f'ROBLEIMS Parents' current .joint custody for Mikey appears untenable as parents' > year battle with each other continutrus unahatcil, with no sign of resolution. rather rages about nmther's alleged abuse (suspicious burn 8/93), neglect (3 days hospitalization 2/94), her "loser" "low life" lac., her perceived attempts to obtain custody of Mikey by throwing him in .jail, ruining him lolally - emotionally, financially and professionally. Mother presents as more reasonable; and supportive of co-parenting. Yet, mother's actions undermine her words as she has brought a civil lawsuit 'Davis Family Child Custody Rc-!:valuation Page 6 against f�ither, repeatedly sought prosecution of" father and made reports alle�2irtg atioils to police and father's probation officers, Mikey's day care, father's %vorl:, and rccenlly initialed CTS evaluation igainst father for suspected physical and sexual abuse. Questions regarding father's emotional, mental, physical stability, as well as his history of violence, or moral, emotional fitness as it parent are raised. Mather dcScribc:; father as a►t erratic, unstable, ,ick, malicious, and devious human being. Oil the other hand, mother's motive in requesting custody is questioned i.e. is mother primarily focused on Mikey's needs or is she using Mikey for profit to get welfare, housing, child support or as "hail", provoking father to lose control in order to get revenge. Both parents are requesting primary physical custody of Mikey. Father would like mother's visitation to coincide with his work schedule (i.e. the first 3 weekends of Tach month). (.)n Ile other hand, norther requests supervised visitation for father. Mother reports fears if she. 4vere granted full custody of Mikey, Father would come after her and kill Mikey ur lici-self' ----- that it' lather cannot have MikL'V, no one can. BEHAVIORAL UPDATi? Parents' prior history was previously reported (5/11/94) and will not he repeated litre. Instead, the focus of this evaluation .will be on the last 2 years. During this interim, I::lizaheth married Ton, lloy October, 1994 and gave birth November, 1995 to her second chili!, a virl n:cined Bailey v.-ho is now 9 months old. Elizabeth continues to go to school 2.3 days a Nvuek, and anticipates receiving her teaching credentials within the next 2 years, allowinpt. her to have a jot, where she will be home when the children are out of school. Michael ohii►ined his contractor's license last year, moved to Salinas, and then went into hiding. Currently he cares for Mikey in it 3-bedroom home with slrong' family support. iie has his own business and hats recently signed a .year contract to work out of the arca the first 3 weekend a month, allowing, hum to he fairly asscssahle to Mikey the remaining time when Mikey is not in preschool. Mikey is enrolled in preschool Monday, Wednesday, and Friday 9- 1. Mother has Mikey enrolled in I Icad Start 1'or I'a l l, 1996. As expected. whenever there are arey area in the court orders, parents het into Iroul-11c. January, 1995, when father withheld 2 visitations from mother because Mikey was sick, then offereil make-up time, Liz filed a police report and insisted on prosecution, when Nticl►acl moved to Salinas (5/4/95) and instructed mother (5/7/95) to pick up Mikey at his Salinas day care (instead of Antioch day care) and there was it misunderstanding (5/21/95) of the modified court order (5/118/95) regarding the day and time of pick up, mothermade police reports father was violating 'Davis Family Child Custody Re-Evaluation rage 7 8/11/96 his TRO by coming up a.day early; More disturbing however arc tilt; allegations of harassment. f.:• izabeth and maternal grandparents report Michael drove by grandparents' house: (6/23/93), :ivied a gun at their honic, and imide approximately 25 phone calls, threatening to kill or fuck them. Apparently, there are no police reports of the alleged gull Incident or Ihrealening phone calm, no tape-recorded messages of Michael, or witnesses other than I'anlily to substantiate these charges. Michael denies these allegations, stating he cannot even call . to make cu lody arrangement or talk to his son without someone reporting he is thrcateninr to kill them: He reports being so scared of their attempts to ruin him that lie initially Ilcd to th,: "-,anctuar'y of his auni's home in Salinas (5/95), then (February, 1996) went into hitting. t:lizabeih repeatedly made reports to polices officers and the probation department father violated court orders, made threatening phone calls, etc.; she appears to have sent a lengthy, disci-c(nnr letter to father's employer (City (ll' Danville), disclosing his violent history and alleging various; business impropriety; p'lizabeth and her attorney humiliated Michael b reporting hitt bailim-y to "' lv:!kc ' day c e; Elizabeth filed a civil lawsuit, ns �a�ell as contempt charges against Michael for failing to rsclose his whereabouts; recently, Elizabeth has filed 2 abuse charges against Michael li)r sexual and physical abuse of Mikey. ;.sic i;ie r. titress tlfi:.l.:yr'i3riils '►�liy :iD ecli�iJi ._-...._.__.'T... .�j�ai:- .... � jy {, %ilaC'Y.Yd%iY2 .�.,L. Mms�lf sllr�++{{�at'rc)ris; tis�'a�e1lats`�.dt:nIctedwif:ever t: �' tont;= tnd resittrcec-ttti 'ili:;tltit y:r .CL?a a 'fl e lY�a.,... ,. =ya:t.Sgc�'.. :!'l�Ptri:+-1J..t(bN.' s.:dN;r•:i:a$.^.,:7:>;.'wdi`��iti, ata`_+..4R^n:J: Y1'e4f:C?'in�`r:�iGs.':;.t._.:nw 'court: Yet he fails to accept rt possibility for,nhis part, showing poor control or judgmt nt in monsto-ins, what he says. Fie ;gi?es :ofr;on�Merfial tirades„ a amst;mi�thct l��r putting Mikey,on Medi-Cal, using hint to get food and housing, while fie sees himself as ttyiu ti�_vl>t�tt�c M,i,l:cy.,�,,� tict:coimtn .t. =tl�c�world�.h :s been,%burned';.1�os ifalize. :riiant ti!';t eci4:l�: .. ... nr ......- : . P ! ). ' ^lib:��ls'1:i•�:'::5::�i.:e�y�<:'-ai :mn'}:yCiV:r;.iy'sit+:. •.,....,:...d�'-_•...-.!Wg_ ," to get someot�e;•_tcl;.ltsten,and do. sonic . ng'hc fci�rr`it is`:a iii Pale:: :a* Mother's civil litigation against father was initiated May; 1994 for, iss,sult and battery, harassment, and confiscation of personal property. Aithough an aFbilrator awarded I lizaheill $2,100 for damages, she proceeded to Irial and obtained a $18,500 settlement (7/16/96). rather has requested (7/26/96) a retrial. Despite mother's nurmcrous all(I"ations, father's probation ended Pchruary, 1996, based on his "good conduct and relorns." Furthermore, his felony oftcnce (273.5 PC Corporal lnjury on Spouse) was reduced to a misdenscanor (6/i (195). Ail allcgmion that Michael was sulking threatening phone calls to mother's attorney and slepl'adle.r was not substantiated by Walnut Creek investigation (7/11/95). Collaterals report Michael has made a noticeable turnaround the past 3 years. i le is described as a hardworking, reliable employee who has matured and calmed down. Significant females in his life report no violent inleractions with him; in fact, in spite of past lights or disagreements with him, they are strong.supporters of father; although it is acknowledged that father has a bad mouth or (CI IIfic:r, eli&is;:_n; tt( ecn;:hist=z Davis family Child Custody Ite-ISv;llualioll Page 8 8/11/96 Mother reports she became suspicious Mikey was being sexually nwlested f"ehruary, 1996 when Mik:-y had an erection while. she was changing him and he stated "Mom, i eat. it." Mother reports Mikey then said "Come on, come on, eat it" and then looked guilty and stuck out his tongue like he was trying to talk her into oral sex. She thinks Mikey then made some comment about father hurting; him. Tom, who is also present, reports the incident occurred aficr Mikey got out of the bath tub and recalls hearing; Mikey say "Mom, kiss it, suck it or licl; it." Butte County CPS was called and interviewed Mikey (2/12/96). Subsecguenily the case ryas closcel as unfounded. When interviewed by Monterey County Sherif("s Department, Ilizahcth admitted prompting; Mikey for the answers. July 8, 1996, Elizabeth brought Mikey to 13ULIC C.'ounty CPS to document bruising; she suspecting; occurred by falttcr using; a belt of- strap on liim. Since Mikey went back and forth ("mommy did it", "daddy did it", etc.) the hruising was barely visible with a non-suspicious appearance, and Mikey's presentation was very limited and nein. credible, the case was again closed as unfounded. Mother reports Mikcy has not hCCal exposed to any sexual activity (movies, magazines, sexual interactions between her and Tom) at their house. Michael denies any sexual or physical abuse of Mikey, seeing, it as mother's attempt to manipulate Mikey. Ile suspects Mikey hears others "had mouth" hill) because lvlikcy sometimes acts very clingy or protective of him if Tina or someone says something ne;;ativc ahuut hirn. On the other hand, maternal grandparents suspect father "brainwashes" Mikey because Mikey appears less excited about coming; over to see them. Over the last couple of years, Mikey is reported to he developing normally although he has sustained a couple of injuries. /April, 1995 while mother %vas shopping; at Big i�ive Sporlin;; Good Store, Mikey I'Lll on some weight lifting equipment and needed 4-5 stitche.s. .1uly ?7, 1996, Mikey received a second degree burn when he fell on his motorcycle while father was in the; process of repairing; it. Mikey also had one cavity. Generally, Mikey is descrihed as an, active, happy, well-adjusted 3 year ') morah old boy. By mother's report, Mikey is doing; well in all areas including; speech, and adapted well to the joint custody routine although she reports Mikey acts sometimes like he is living 2 lives. When Mikcy is with mother, lie reportedly does not talk about his life with father and vice. versa. Dad expresses more concern about the joint custody arrangement I'or Mikey, primarily hC:CUISC of his perceived concerned over Mikey's safety, Mikey's need to settle down, and some possible: spr;ech problems being monitored by his pediatrician and neurologist, DI-. Siehcrr. Mikey is ;IISO reported to tune-out and ignore .requests; his day care provider has questioned his hearing, and his -Aint expresses some concern about what she perceives sometimes as a "hollowness" or "emptiness." Melissa, father's previous girlfriend, who picked up Mikey from ruother last year at transition, reports concern about Elizabeth's attempt to manipulate Mikey to resist leaving; her. .On one occasion', Melissa reports Elizabeth waking; Mikey up I'rrnrr a deep sleep by rolling, Mikey into her daughter's arra, when Mikey startled and started crying;, l.lixahcth immediately . Davis F=amily Child Custody Re-Evaluation Page 9 8/11/96 whipped the video camera out in order to document Mikey's "distress" in leaving her. Maternal grandmother and mother report Mikey frequently cries when it is time to Lo to falher while father, Melissa, and Tina report the reverse. Mikey is reported to he doing well socially. ire plays with a 5-6 year old nci, lihor boy on a daily basis, generally outside, when he is at mother's. 1=ather's day care reports Nl ikey gets along very well with children. Ile has a particularly strong tic to his cousin .lake who is 6 weeks younger than himself. They reportedly often spend days together in day care and up Io 3 overnights a week when Mikey is with father. Father is helping to coach Mikey's soccer team and also takes hire to swimming lessons 2-3 times a week. Both parties are described as wonderl'ul parents by collaterals. Iair.abeth is adnrif-W for her loving patience, her pleasure in playing games with the children, teaching Mikey songs and providing education Stimulation. Elizabeth reports loving to take Mikey and B;1iley 10 the Bark and her various Chico Mother Club activities. ichael-•isgrepeatedl. AICSC6hCLl,AS;a�v,et:. - , wa — _.......... .._.. ,... .. ,;, ;. ',� .,. .. ham..._ ��.•:�: .;,. r.- rmnressrv.ecley,oted ;dad who::rs:.craz _ a1,,.,ut:.ivlikey >,.;,.,cie.;wliiisilylult' ilisie::.. o ,ggyc and weir:hirl�` 10-Le, uruch 4over hrtn ::or: ts;toy:'ipy7�I►7.tent:=;Ni1 <me;hati i)bsc.rved Mict>�CLa'. ' => •R:..lw.... .. .. _ 7 ` f. .+.Yy�9,0.:J. shmV..l e Slightest sign i�(' aI iiil':Mik:cy' Mikey is`ilcscrihcd'as cxtr�mi y hondul to I.Ultt.r,_ '' whenwer:TdaJkis °iiioutid; :Mikey:'reported ly refuses to,have:.much•.to =do:with'-any`oilier', i tt : resent:`: : Elizabeth believes she Should have custody of Mikey because she has csutblished a stahlc, loving family unit with a SlSter and SLep-dad for Mikcy, in a 2-hedroom homu with a larue hackyard. i'aternal grandparents have a pony for Mikey and a trampoline on which he love.~ to hounce.. Mothcr hclieves lather is too erratic, violent, and emotionally unStahlc to 1%111-nl Mikey. Shc reports being stressed and "nunth" by father's harassment. HNA LUA'f iON Mikey is an active, motorically orientated child who physically and tcinperaniew,01y resembles f_,ther — he looks and acts very much like father which ohviouSly plcaseS dad very nnrcli. The two of them interact physically, verbally and playfully very Happily together, there is a very strong bond with lots of glee, excitement, joy and energy. W r l£they are— togejher�itlicjr;tic_lli ` ;g1ow,Cach time Mikey was delighted to see dad — there was no resttance or sadness 'cvtcicr7t about leaving masher. Instead, Mikey would dash off, with little backward glance to mother. While waiting alone with me for father to arrive, Mikey sang and stated "I happy to see daddy" but repeatedly failed to respond when I would question him shout hcing Sad al leaving mother, "sister" or papa. Although the attachment between Mikey and Hither was obWiously stringer, Davis family Chilo Custody Re-i valuation Page 1 I 8/11/96 has rebuilt some hridges with his father. Ills family support system Inas heen very helpful in dealing with his custodial crisis. in spite of Michael's faults, it is clear his heart is in the right place in regards to Mikey. lie is overly identified with Mikcy, yet caring. Around Mikey, father becomes loving, warm, mellow, patient, soft, etc. ile clearly loves talking about Mikey, interacting with him, taking hire places, putting himself out for Mikey, or being a parent. Michael is very achievement orientated, recognizes the need to settle flown, to provide more physical stability for Mikey. lie is open to input from others (except for the need to maintain verbal control) and has set up a strong support network for himself and Mikey. Elizabeth appears more "settled in," comfortable, and haply with life and her support system. Marriage appears to have been good for her. Psychological testing shows some notable changes suggestive of less disturbed, narcissistic functioning. She was more engaged with Mikey, appeared to experience more pleasure with him, and seemed more confident. intervening with him. On self report (MMPI-2), mother presents herself as well adjusted and not experiencing any type of stress, denying depression, anxiety or worry. As bel'ore, there are signs F'.lizabctlr resists dealing with the serious side of life, finding introspection, rules, or sell".-discipline tedious. When things get difficult, she tries to escape into fantasy, deny reality,.or look to other to meet her needs instead of assuming responsibility for herself. She is very defensive about looking at herself, attempting to present a facade of "normality" but lacks the energy or resources to sustain the effort under scrutiny. Repeatedly on the Rorschach, iairabcth would proicct popular whole responses, then cut oft some part. She repeatedly cut-off or simplified experiences perceived as ambiguous or complex. Thus she is prone to experience difficulty interacting in her enviromrlent, without a lot of external support, since on her own, Elizabeth disregards too many aspects of a situation, escapes too often into a fantasy world, or acts out unconsciously. Bast-j on Elizabeth's defensiveness and limited self insight, her actions tell more Ihan her words. What becomes apparent then is that, when it comes to caring for Mikey instead of stirring up father, she does not look as good. For instance, although Elizahcth picked up Mikey approximately 15 times across the street from his day care last year, she never once called to - ask how he was doing, to request staff to inform paternal grandfather waiting 1-2 hours outside with Mikey that she was running late, or come to observe Mikey, in spite of an open invitation, - instead nwlher's only contact was to humiliate father by reporting his abusive assault on her. During Illy observations, mother was more interactive with Mikey than before. Yet in our last session, she was so focused in telling me (within ear shot of Mikey), that she fears father would "get" Mikey or herself if'she were awarded full custody, she Forgot to say goodbye (for a week) _ to Mikey. When asked detailed questions about Mikey, she seemed less k116xvIedocahle about him. 1-2 years ago, mother reportedly stated she was ready to let father have custody. Finally, bavis Family Child Custody Re-Evaluation Page 10 8/11/96 also observed Mikey responding well to mother. lie seems comfortable and responsive to her. Mother was good about giving Mikey choices, "teaching" him colors, numbers, etc., songs, and recognizing his needs for limits. Much of Mikey's play at transitions between parent focuses] on a pop-out snowman who repeatedly disappeared — symbolically acting out his own coming and going. Othcr play associations involved hattles hetwcen parents, with etch one tlireatcning to kill the other. Although Mikey appears behavioral to transition well between the parents, I observed same speech problems (articulation errors and less communication), some tuning out, and some "blankness". At this point it is too soon to determine if' Mikey may be showing, early symptosis of attention deficit disorder, or whether his behavior reflects some attachment disorder associated with the split custody arrangement, his need for more stability, or some difficulty in mother- child bonding. it was my impression there was less of this "detachment" when Milcey was interacting with dad or his cousin Jake. Aside from one interview where Mikey appeared to conk coached I"rom mom to report indiscriminately "daddy did it," to various questions, 1 saw no indication father was abusing; Mikey. Instead, Mikey's projective free play, his various affective non-verhal reactions, as well as his response to verbal questions, (open-ended, as well as directed) show no evidence of ahuse. Yet, 1 did have concern one session mother appeared to be teaching Mikey father was abusing; him. His responses that session appeared a.:tomatic, dissociated from his affect, inappropriate to the questions asked, or the location of the bruise to which i was pointing. Throughout my contact, Mikey consistently denied with convincing affect or other symbolic play, any sexual experiences with his "weener" or other people's. Micheal continues to present as'a highly reactive, naive male who is lax ab(11.1t contrnllinq his cmotional display or verbal output. He frequently calls attention to himself by his air rig' imperturbability and the intensity with which his feelings are expressed — particularly since his judgment may be poor, his reactions oppositional, or his thinking loose and distorted. It is easy to pull his "chain" because Michael is so fearful of losing custody of Mikey, or "bait" him into believing one is messing with him or Mikey. Currently he is under it lot of situational relaled stress and subject to intense experiences of depression and/or affective disruption. Ile sometimes appears to have "tunnel vision;" thus in ambiguous situations, he i'OULISeS 1.00 often on irrelevant detail, missing the overall gestalt. Other times he triers to get reality to conform to what lie wants to believe or perceive. His thinking can be loose and his reasoning hard to follow. lie can be very defensive about revealing himself. Although Michael can be intense, negative, angry, and devaluing of mother, he has managed to maintain behavioral, if 1101. verhal, cc t ol. F=urthermore, there was no evidence of psychopathic tendencies — .. t c. annoying thein-ireatentng-or=violenr 'fFe-'(spears to show some ealining; clown or maturing and Y. D:,vis Family ' Child Custody Re-Ivalualion Page 12 ' 8/11/96 Elizabelh maill. ,cut III-,Inv allegations was unable to substantiate e.g. Mikcy was returned to her care /2/96) with an infected, pussy burn; Mikey's first cavity clue to falher's negligence.; father's sister Jenniler reports father is often "mean" to Mikey; Mikcy repcatedly cries and resists going to father for visits; she continues to experience post-traumalic .symptortrs associated with father's assault of her while her'testing revealed no stress; paternal grandparents favor their other grandchildren over Mikey; father is sexually-physically abusing Mil<cy. RECONIMENDAnONS This case is a disturbing one for both parents seem more invested in destroying each other than recognizing Mikey's need to be in a safe protective spot, out of the middle of'the cross fire, free to love each of them. Since mother's apparent willingness to use Mikcy as "bait" to incilc father and to teach Mikey father is sexually and physically abusing him, appear more psychologicaliv damaging, i did not see her as the preferred custodial choice. It is also vicar that h1ikey Ira,: a stronger emotional bond to father, and api cars to be the type of child who does better in a custodial arrangement with the father. in spite of father's temper and history of violence, he appears very invested in raising Mikey properly. lie has a strong famify supporl system in place, is open to input from others, has established a positive ongoing, therapeulic. professional relationship and has readjusted his work schedule to accommodate Mikey's needs. 'Thus I recommend father he given physical custody of Mikey with mother to have visitation while father works (first.3 weekends each month). This recommendation is haled on the condilion father continues in therapy with John Kincaid, Ph.D. Hopei'ully, this arrangement will diffuse the parental battle, allowingfather to support Mikey's needs for mother. i did not see evidence mother was abusing drubs or an "unfit" mother — mostly she seems unconscious ahold uSiltl; Mikey to act out her anger and revenge at father. Because of the physical distances between the parents, it may be a6isable to set up a holiday schedule where the holidays float, i.e. mother would he entitled to take whichever holidays full on a Monday or Friday on the first 3 weekends per month, with the.exception that she: would he entitled to Mother's Day each year, Christmas eve odd ye�rrs, s►nd Christnu►s day even years. Each parent should he entitled to 2 weeks vacation with Mikcy each sununrer, with 2 month written notice to the other. Legal custody would continue to be shared. Mother would pick up Mikey I p.m. Friday from day care; father would pick up Mikcy at Chico Police Station 6 p.m. 2Sunday. It is also recommended that Mikey has a hearing evaluation to rule out any. problems and that father follow through on recommendations for a speech program for him. MARLENE B CKiNC;, Ph.D. Licensed Psychologist PSY4550 'pes Posp C========PlTlMEV BOWES 119 1 111 1 1 1111111111111 1111 : " 02 IIV 7006 3450 0000 3997 7248 00021P 56099 APR00721.300 2008 - MAILED FROM ZIP-CODE 94561 .7 7, pipP 2 C6 / C LA INI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: � ' _ Claim Against the County, or District Govemed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TOCLAMANT and Board Action. All Section references are to ). The copy of this document mail to51 California Goverrunent Codes. D �gj��f you is your notice of the action t n on your claim by the Board of MAY 2 O 2008 Supervisors. (Paragr1ph IV below), given Pursuant to Gpvernment Code a� COUNTY COUNSEL Section 913 and 915-.4. Please note all AIMOUNT: - MARTINEZ CALIF.. `Warnings". CLAIMANT: �jre_ncb_> Ire -to ATTORNEY: K/a, DATE RECEIVED: mayZ� ADDRESS: DQbLS j3UrbaCk S BY DELIVERY TO CLERK ON: CA. 61410()1 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CUL �N �le,,l Dated: WW ao 'Woo. By: Deputy ) (lv II. FROM.: CountyCounsel TO:. Clerk of the Board of Supervisors (Tis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send waming of claimant's right to apply for leave to present a late claim (Section 911.3). ( ). Other: Dated: By: Deputy County Counsel 1.11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. ,BOARD ORDER: By unanimous vote of the Supervisors present: („)' This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. d JOHN CULLEN, CLERK, ByARX4�eputy Clerk WAR N Gov. code section 913) Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a court action on this cNint.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection witir this matter. If'you want to consult an attorney,you should do so immediately. *For Additiaml Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that i. am [low, and at all tinies herein mentioned, have been a citizen of the United States, over age 18; and that today .1 deposited in the United States Postal Service in [Martinez, California, postage fully prepaid'a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. e Date . o JOHN CULLEN, CLERK By Deputy Clerk -7 2 / /U Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31,. 1987, must be presented'not later than the l 00th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any. other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with Jane Pennington, Clerk of the Board at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553, either by mail or in person. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity; separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp Brenda Ireland Against the County of Contra Costa y or The Housing Authority of Contra Costa (District) CLERK (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of and in support of this claim represents as follows: 1. When did the damage ori jury occur? (Give exact date ana hour) s2 124 a (m Cys 2. Wliere did the damage or injury occur? Include city and county) OR17Z, V'11 116 41e, AJ& 3. How did the damage or injury occur? (Give full details;)use extra aper if reciulredj j 4. What particular act or omission on the part of county or district officers, servants or. employees caused the injury or damage?AteC)UIZ clmform lCK L', LUa"s r,, E _�kVL_,>4re c y � ��►'til C) c, P>G 2 ( C�,�1 �F2 ( (Z, , 5. Wha are the names of county or district officers, servants or employees causing the damage or injury? ot 6: What damagdoror i�ies do you claim resulted? (Give full extent of injuries or damages claimed. 'Attached two estimates for auto damage.) VA 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8.,.Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 11A, Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney 0 (Claimant's Signature) 1 (Address) Telephone No. Telephone No. :��J NOTICE` Section 72 of the Penal Code provides: "Every person who, with intent to defraud; presents for allowance or for payment to any state board or officer, or to any.county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding, ten thousand dollars ($10,000) or by both such imprisonment and fine." clmform Date: 05/14/2008 09:53 AM Estimate ID: 1735 Estimate Version: 0 Preliminary Profile ID: Standard Karber's Auto Body 405 24th Street,Richmond,CA 94804 (510)234-1204 Fax: (510)234-7302 Tax ID: 68-0006699 BAR M AL098693 EPA M CAL000188794 Damage Assessed By: Jose Gonzalez Payer: Customer Deductible: UNKNOWN Owner: B IRELAND Mitchell Service: 914774 Description: 1988 Nissan Sentra XE Body Style: 2D Cpe Drive Train: 1.61-Inj 4 Cyl License: 2HNM531 CA Color: BLUE MET Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 AUTO BDY. OVERHAUL FRT BUMPER COVER ASSY 2.5 # 2 401200 BDY REMOVE/REPLACE FRT BUMPER COVER 62022-65A25 283.52 INC # 3 401260 BDY REMOVE/REPLACE FRT UPR BUMPER COVER RETAINER 62290-65A01 22.67 INC 4 401460 BDY REMOVE/REPLACE FRT BUMPER IMPACT CUSHION 62090-65A00 111.25 INC 5 401490 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT BAR 62030-65A30 164.53 INC 6 403360 BDY REMOVE/REPLACE L PARK/SIGNAL LAMP ASSEMBLY 86115-69A00 61.48 2.0*# 7 900500 BDY* REMOVE/INSTALL LT FDR W/O MLDG Existing 0.3* 8 409100 BDY REPAIR L FENDER PANEL Existing 2.0*# 9 AUTO REF REFINISH L FENDER OUTSIDE C 2.3 10 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL. 3.00 11 AUTO REF ADD'L OPR CLEAR COAT 0.9* 12 933018 REF ADD'L OPR MASK FOR OVERSPRAY 5.00 * 0.2* 13 933019 BDY ADD'L OPR TAPED STRIPE 10.00 * 0.3* 14 AUTO ADD'L COST PAINT/MATERIALS 96.00 * -Judgment Item # - Labor Note Applies . C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 05/14/200809:53:45 1735 Mitchell Data Version: OEM: APR-08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 1 of 3 UltraMate Version: 6:5.017 All Rights Reserved Date: 05/14/2008 09:53 AM Estimate ID: 1735 Estimate Version: 0 Preliminary Profile ID: Standard Estimate Totals Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 7.1 70.00 10.00 0.00 507.00 Taxable Parts 643.45 Refinish 3.4 70.00 5.00 0.00 243:00 Sales Tax @ 8.750% 56.30 Non-Taxable Labor 750.00 Total Replacement Parts Amount 699.75 Labor Summary. 10.5 750.00 111. Additional Costs Amount IV. Adjustments Amount Taxable Costs 96.00 Customer Responsibility 0.00 Sales Tax @ 8.750% 8.40 Non-Taxable Costs 3.00 Total Additional Costs 107.40 I. Total Labor: 750.00 H. Total Replacement Parts: 699.75 Ill. Total Additional Costs: 107.40 . Gross Total: 1,557.15 IV. Total Adjustments:. 0.00 Net Total: 1,557.15 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair: -PARTS PRICE'S SUBJECT. TO- CHANGE- Due to many unforeseen circumstances in the repairing of automobiles, We regret that We can only estimate, not promise, a completion time. Your understanding is greatly appreciated. I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate above vehicle for purposes of testing, inspection or, delivery at my risk. An express mechanics lien is acknowledged on above vehicle to .secure the amount of repairs thereto. It is also understood that you will not be held responsible for loss or damage to cars or articles left in cars in case of fire, theft or any other cause beyond our control. REPAIRS AUTHORIZED BY DATE ESTIMATE RECALL NUMBER: 05/14/2008 09:53:45 1735 Mitchell Data Version: OEM: APR_08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 2 of 3 UltraMate Version: 6.5.017 All Rights Reserved' ' Date: 05/14/2008 09:53 AM Estimate ID: 1735 Estimate Version: 0 Preliminary Profile ID: Standard Repairs are to be paid upon delivery of vehicle. Please make arrangements to have cash,. insurance check, credit card or cashier' s check at that time (No personal checks) . Any additional repairs related to this loss should be brought to our attention for further repairs or all guarantees are void. All parts guaranteed as per manufacturers warranty, !all workmanship guaranteed for as long as you own your vehicle. , ----,----------------------------------------------------------- ------- POWER OF ATTORNEY I do hereby appoint the aforementioned business as my attorney in fact to accept on my behalf any and all checks, drafts, or bills of exchange for deposit of the aforementioned business account for credit on my account for repairs on my vehicle which has been released and accepted. ACCEPTED BY DATE I hereby authorize the above repair work to be done along with thenecessary materials. You and your employees may operate above vehicle for purposes of testing, inspection or delivery at my risk. Anexpress mechanics lien is acknowledged on above vehicle to secure the amount of repairs thereto. It is also understood that you will not be held responsible for loss or damage to cars or articles left in carsin case of fire, theft or any other cause beyond your control. ESTIMATE RECALL NUMBER: 05114/200809:53:45 1735 Mitchell Data Version: OEM: APR_08_V UltraMate is a Trademark of Mitchell International Copyright(C)1994-2008 Mitchell International Page 3 of 3 UltraMate Version: 6.5.017 All Rights Reserved., 05/14/2008 at 09: 33 AM Job Number: 78190 LA-TECH AUTO BODY License # :AB220122 Federal ID # : 010637644 CUSTOMER SATISFACTION IS OUR #1 GOAL 2311 RHEEM AVENUE RICHMOND, CA 94804 (510) 234-504.4 Fax: (510) 234-0642 PRELIMINARY ESTIMATE Written By: Adjuster: Insured: IRELAND Claim # Owner: IRELAND Policy # Address : Deductible: Date of Loss: Day: .�r� - sjS r)�� Type of Loss: Evening: Point of Impact: Inspect LA-TECH AUTO BODY Business: (510) 234-5044 Location: 2311 RHEEM AVENUE RICHMOND, CA 94804 Insurance Company: Days to Repair 1988 NISS SENTRA SE 4-1 . 6L-FI 2D CPE Int: VIN: JNlPB24SiJU030993 Lic: Prod Date: Odometer: Rear Defogger Tilt Wheel Intermittent Wipers Rear• Window Wiper Tinted Glass Body Side Moldings Dual Mirrors Console/Storage Flip Roof Power Steering Power Brakes AM Radio FM Radio Stereo C1oth .Seats Bucket Seats Recline/Lounge Seats 5 Speed Transmission Overdrive Aluminum/Alloy Wheels ------------------------------------------------------------------------------- NO. OP. DESCRIP'T'ION QTY EXT . PRICE LABOR PATNT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2 0/H front bumper 2 . 5 3** Repl RECOND .Bumper cover 1 192 . 00 incl . 0. 0 4 Rep! Bumper cover retainer upper -1 22 . 67 incl . 5 Repl Energy absorber 1 111 .25 Incl . 6 Repl Reinforcement 1 164 . 53 Incl . 7 FRONT LAMPS 8 Repl LT Side marker lamp 1 61 . 48 0 . 3 9 FENDER 10* Rpr LT Fender 1 . 5 2 . 3 11# TINT COLOR l 0 . 5 12# COVER CAR 1 6. 00 0 . 3 13# HAZARDOUS WASTE 1 6. 951 ------------------------------------------------------------------------------- Subtotals =_> 564 . 88 5 . 1 2 . 3 1 05/14/2008 at 09 :.33 AM Job Number: 78190 PRELIMINARY ESTIMATE 1988 NISS SENTRA SE 4-1 . 6L-FI 2D CPE Int: Parts 564 . 88. Body Labor 5 . 1 hrs @ $ 75 .00/hr 382 . 50 Paint Labor 2 . 3 hrs @ $ 75 . 00/hr 172 . 50 Paint Supplies 2 . 3 hrs @ $ 35 . 00/hr 80 . 50 --------------------------------------------- ------ SUBTOTAL --------------------------------------------------- SUBTOTAL $ 1200. 38 Sales Tax $ 645 . 38 @ 8 . 75000 56. 47 ---------------------------------------------------- GRAND TOTAL $ 1256. 85 ADJUSTMENTS : Deductible 0 . 00 . ---------------------------------------------------- CUSTOMER PAY $ 0 . 00 INSURANCE PAY $ 1256. 85 THIS ESTIMATE HAS BEEN PREPARED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE . PART PRICES ARE SUBJECT TO INVOICE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OF YOUR VEHICLE. THIS ESTIMATE DOES NOT INCLUDE COSTS OF REPAIRING ANY HIDDEN DAMAGE FOUND ON TEAR-DOWN. THIS BODY SHOP IS NOT RESPONSIBLE FOR ANY EXISTING UNRELATED PRIOR DAMAGE OTHER THAN STATED ON THIS ESTIMATE OF REPAIR. ***NOTICE*** DUE TO MANY UNFORSEEN CIRCUMSTANCES IN THE REPAIRING OF AUTOMOBILES, WE REGRET THAT WE CAN ONLY ESTIMATE, NOT PROMISE, A COMPLETION TIME. YOUR UNDERSTANDING IS . GREATLY APPRECIATED! 2 r u 0 /19/2008 at 09: 33 AM Job Number : 78190 PRELIMINARY ESTIMATE 1988 HISS SENTRA SE 4-1 . 6L-FI 2D CPE Int : FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR ABBREVIATIONS/SYMBOLS : D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: B=BODY LABOR D=DIAGNOSTIC E=ELECTRICP_L F=FRAME G=GLASS. M=MECHANICP_L P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLVD=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL R.ECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/ =WITH/ SYMBOLS : #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTE S ATTACHED T0. LINE. MQVP=MANUFACTURER' S QUALIFICATION AND VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. N.WCPP=NATIONWIDE CRASH PARTS PROGRAM. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AOF3612, CCC Data Date 09/01/2008, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehic le. dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.. OPT OEM or ALT OEM parts may include "-le M4 parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Nor.-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used pares are described as LKQ, Qua! Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Soecifications. Labor operation times listed on the lite with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sian (#) items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, .labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 3 L jou rZ (fe—CK �lCA 14 C�.CQI� dr ME 6A.4D RECEIVE MAY c 008 rA 9,,F- P--A//V �"�'n ��. CLERK oN,r D(7F!3T if;`k iSvfiS ROOM 1 0`� C APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT �i Z Against the County, Routing ) The copy of this document mailed to you.is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board'of Supervisors (Paragraph III, below), California.Government Code.) I� La)'note the "WARNING" below. i Claimant: C �� ,1,-� n ,UN U 4 200$ f �,e �r^^ COUNTYCOUNSEL Attorney: fuC MARTINEZ CALIF. !,c Address: (moo � 9wo) � _38 MorI�-t .� fan , . � - n Amount: By delivery to Clerk on: uW i Date Received: June 24 IWO By mail, postmarked on:`nQf U�� 41�� I. FROM: Clerk of the Board of Supervisors TO: . County Co nsel Attached i��sa copy of the above noted Application to File Late Claim. DATED 'T JOHN, C['LLEN, Clerk,By: DEPUTY II. FROM: County Counsel TO: Clerk of thejBoard of Supervisors ( . ) The Board should grant this Application to File Late Claim (Section 911.6)i The Board should deny this Application to File Late Claim :(Section 911.6). DATED: �C..� �1��� SILVANO B. MARCHESI, County Counsel, By: / �. �_DEPUTY III. BOARD ORDER By:;unanimous vote of Sup'erv�sors present (Check one only) ( ) This Application is granted (Section 911.6). ( Vr/ This Application to File Late Claim is denied (Section 911.6). I certify that this,a true and correct copy of the Board's Order entered in its minutes for this date. DATE• 0,0 JOHN CULLEN, Clerk, By: DEPUTY WARNING (Gov. Code §911.8) If you wish to file a court action on this matter,you must.first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your al0cation for leave to present a late claim was denied.. You may seek the advice of an attorney of your choice In connection with this matter. If you want to consult an attorney,you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy.of this document, and a memo thereof has been filed and endorsed on.the Board's copy of this Claim in accordance with Section 29703. DATED: ®/a -?AW JOHN CULLEN', Clerk,.By: DEPUTY V. F 1\I (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By: County Administrator, By: APPLICATION TO FILE LATE CLAIM THE DOLAN BUILDING CBD FRANCISJ.SHEHADFK ATTORNEY 1438 MARKEI'STREET (41.5)421-2800 TEL SAN FRANCISCO,CA 94]02 `�C'HE )OLAN LAw ]FIRM (41.5)421-2830 FAX 'May 30, 2008 Via Certified Mail RECEIVED Clerk of the Board of Supervisors JUN e 2 2008 Room 106 County Administrative Building CLERK BOARD OF SUPERVISORS 651 Pine Street CONTRA COSTA CO. Martinez, CA 94553 Re: claim of Steven Kittelson To Whom This May Concern: Please find enclosed one original application for permission to present late claim, signed .in blue ink, and two copies. Please date endorse one copy and return to me in the self-addressed . stamped envelope. Thank you kindly, Francis J. Shehadeh enclosures RECE VE® 1 Christopher B. Dolan (SBN 165358) Francis J. Shehadeh (SBN 251130) JUN 0 2 2008 2 THE DOLAN LAW FIRM 1438 Market Street 3 San Francisco, California 94102 CLERK BOARD OF UPER isoRs Telephone: (415) 421-2800 4 Facsimile: (415) 421-2830 5 Attorneys for Claimant STEVEN KITTELSON 6 7 8 " 9 10 In the Matter of the Claim of. APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM I 1 STEVEN KITTELSON, [Gov. Code Sec. 911.4] 12 V. 13 14 COUNTY OF CONTRA COSTA. 0RIGINAL. 15 I 16 TO: COUNTY OF CONTRA COSTA 17 Application is hereby made for permission to present the attached claim ager expiration of the 18 time limit provided in Government Code Sec. 911.2. I, Francis J. Shehadeh,hereby declare as follows: 19 1. 1 am an attorney licensed to practice law in the State of California and am an associate at The 20 Dolan Law Firm, counsel for Claimant Steven Kittelson. I make this declaration in support of this 21 application for permission to present late claim. 22 2. As stated in the attached claim, claimant's cause of action accrued on or about October 7, 2007. 23 The time for presentation of such claim under Government Code Seca 911.2 expired six months 24 thereafter, on or about April 7, 2008. 25 3. On March 6,2008,I mailed via U.S. Mail the attached claim under cover of letter,also attached, 26 and addressed to the following address: 27 Clerk, Board of Supervisors County of Contra Costa 28 651 Pine Street Martinez, CA 94553 APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM 1 I I mistakenly did not specify Room 106. 2 4. On May 29, 2008, 1 called the Clerk of the Board of Supervisors and spoke to Ms. Jane 3 Pennington to inquire about the status of the attached claim. Ms. Pennington was very helpful and 4 searched for record of receipt of the claim. She could not find.record of receipt of this claim. I told her 5 that I sent the claim to the aforementioned address, and she remarked that I did not specify Room 106. 6 5. I do not know why exactly the County of Contra Costa has no record of receipt of the claim. 7 However,given my minor neglect in failing to specify Room 106, I can only postulate that the claim got 8 lost in the shuffle of the County's mail and never arrived at Room 106. 9 6. Under the foregoing facts,I now make this application for permission to file a late claim on the 10; grounds of my"mistake, inadvertence, excusable neglect," and that the County of Contra Costa is not 11 prejudiced in defense of the claim by service of the claim now. (Gov. Code Section 911.6(b)(1).) My 12 neglect in failing to specify Room 106 in the address was minor. I sent the claim to the proper office, 13 that is, to the "Clerk, Board of Supervisors" of Contra Costa County, and I exercised diligence,in 14 investigating this claim, as.1 timely filed the claim with the County of Contra Costa. No facts support 15 a finding that the County is prejudiced by accepting the claim now,as the six month statute of limitations 16 for presentation of the claim, April 7, 2008, is only less than two months from today. On,,the 17 aforementioned grounds, I respectfully request that the County of Contra Costa grant this application 18 for permission to present late claim. 19 I declare under penalty of perjury under the laws of the State of California that the foregoing is 20 true and correct. Executed this 30'h day of May, 2008. 21 22 THE DOLAN LAW FIRM 23 24 25 26 Fra pis J. Shehadeh 27 28 -2- APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM THE DOLAN BUILDING CBD FRAI\;CIS J.SHEHADEFL ATTORNEY 1438 MARKET STREET (415)421-2800 TEL SAN FRANCISCO,CA 04102 THE DOLAN LAV FIRM (415)421-2830 FAX March 6, '_'008 Via U.S. Mail Clerk, Board of Supervisors County of Contra Costa, 651 Pine Street Martinez, CA 9=1553 Re: clairFt of Steven Kittelson To Whom this May Concern: Please find enclosed two copies of a government claim for personal injuries filed by claimant Steven Kittelson. Please date stamp one of them and return to me in the self addressed anis stamped envelope. Should you have any questions, please call me. Very truly yours, Francis Shehadeh enclosures CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE UNINCORPORATED DISTRICT OF WALNUT CREEK, BEAT 22, COUNTY OF CONTRA COSTA Clerk, Board of Supervisors 651 Pine Street Martinez, CA 94553 7 Claim By: Steven Kittelson The undersigned claimant hereby makes claim against the County of Contra Costa and the unincorporated district of Walnut Creek, Beat 22, in a sum which exceeds $10,000.00 and which will be an unlimited jurisdiction suit, and in support of this claim represents as follows: I. When did the damage or injury occur? October 7, 2007, at approximately 9:35 a.m. 2. Where did the damage or injury occur? Unincorporated section of Walnut Creek, Contra Costa County, Beat 22; approximately 6 feet north of the south roadway edge of eastbound Wildcat Canyon Rd. and .3 miles west of the west roadway edge of San Pablo Dam Rd. 3. How did the damage or injury occur? Claimant was riding his motorcycle eastbound on Wildcat Canyon Rd. at a rate of speed below the legal speed limit and rode over loose asphalt and/or gravel on the road and within the fog limit line, causing him to lose control of his motorcycle. The next thing that Claimant remembers is walking up laying on his left side on the road with his motorcycle laying on top of him. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Contra Costa County and the unincorporated district of Walnut Creek, Beat 22, are liable for Claimant's injuries because the defect which caused Claimant to lose control of his bike is a dangerous condition of public property. The portion of Wildcat Canyon Rd. where he was injured is owned, controlled and/or maintained by the County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22. CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE UNINCORPORATED DISTRICT OF WALNUT CREEK, BEAT 22, COUNTY OF CONTRA COSTA (page 2 of 4) The portion of Wildcat Canyon Rd. where he was injured constituted a dangerous condition of public property as it was physically damaged, deteriorated and defective in such a way as to forseeably endanger those using Wildcat Canyon Rd., including but not limited to, the edge of the roadway where Claimant's injury occurred had loose gravel and/or asphalt of the same color of the roadway and located at a turn in the roadway without signs warning Claimant of said loose gravel and/or asphalt, creating a trap for the unwary motorist. The dangerous condition on Wildcat Canyon Rd. where he was injured constituted a significant and non-trivial defect and was not safe and fit for the use of vehicular traffic. His injuries were directly and proximately caused by this dangerous condition on Wildcat Canyon Rd., which is owned, controlled and/or maintained by the County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22. The County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22, have an affirmative, non-delegable duty to warn the public of dangerous conditions on the public freeways to keep them safe for vehicular traffic and that their failure to give such warning directly and proximately caused her injuries. Furthermore, claimant's injuries were not caused by negligence on her part as he did all that was required of a reasonably prudent driver and exercised reasonable care to avoid injury. The County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22, have an affirmative, non-delegable duty to inspect and maintain the public roadways to keep them safe for vehicular traffic,and their failure to inspect and maintain the section of Wildcat Canyon Rd. where he suffered injury directly and proximately caused his injuries. Due to the deteriorated condition of the section of Wildcat Canyon Rd. where he suffered injury, this dangerous condition had existed for`such a period of time and was of such an obvious nature that the County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22, in the exercise of due care, should have discovered this condition and its dangerous nature, but failed to do so. This dangerous condition on Wildcat Canyon Rd. existed glue to the negligent or wrongful act or omission of an employee, or employees, of the County of Contra.Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22, while acting, or failing to act, within the scope of their employment. Said employees CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE UNINCORPORATED DISTRICT OF WALNUT CREEK, BEAT 22, COUNTY OF CONTRA COSTA (page 3 of 4) negligently failed to properly pack the loose gravel and/or asphalt, negligently placed the loose gravel and/or asphalt on the roadway, negligently failed to clean up the loose gravel and/or asphalt, negligently failed to properly maintain the roadway and/or negligently failed to properly warn Claimant of the loose gravel and/or asphalt. Alternatively, the County of Contra Costa and/or unincorporated section of Walnut Creek, Contra Costa County, Beat 22, had actual or constructive notice of the dangerous condition of public property a sufficient time prior to Claimant's injuries to have taken measures to protect against the dangerous condition of public property, but failed to do so. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time. 6. What damage or injuries do your claim resulted? [sic] Claimant's injuries include but-are not limited to a concussion, broken left ankle, abrasion on lett knee, pain on left shoulder, neck, and lett hip. Claimant.has incurred and will continue to incur special damages including but not limited to past and future medical expenses, past and future wage loss and property damage in an amount which exceeds $10,000. Claimant has one damage estimate to his motorcycle at this time, attached herein as Exhibit'A. Claimant has incurred and will continue to incur general damages Oincluding but not limited to pain and suffering, emotional distress, anxiety, fright, inconvenience, loss of enjoyment of life and disfigurement. This is an unlimited Jurisdiction claim. 7. How was the amount above calculated? The amount of special.damages were calculated based on an estimation of medical expenses, wage loss and property damage. The amount of property damage was based on an estimate by Santa Rosa Powersports, Inc., attached as Exhibit A. The amount of general damages was estimated based on the pain and suffering that claimant has and will continue to suffer, as well as on the amount of special damages which claimant has and will continue to suffer. CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND THE UNINCORPORATED DISTRICT OF WALNUT CREEK, BEAT 22, COUNTY OF CONTRA COSTA (page 4 of 4) 8. Names and addresses of witness, doctors, and hospitals: not required by Government Code section 910 9. Expenses and damages not to be listed pursuant to Government Code section 910(fj. Send notices to Claimant's attorney, Christopher B. Dolan, The Dolan Law Firm, 1438 Market Street, San Francisco, CA, 94102, telephone 415-421-2800, fax 415-421-2830, email francis@cbdlaw.com. Signed by attorney Christopher B. Dolan on behalf of Claimant: i Date: March 6, 2008 THE DOLAN LAW FIRM Zome �&2aimant PB. DO AN STEVEN KITTELSON Jan 24 08 02:33p Steven Kittelson 707 538 2999 p. 3 %mta Rosh( Power;ports, in�.:.= _.� 5atia �a_a ave BE KAN RE 2=:4 UFRNT DR 1:1 Yr Malo model Color C11ea Plitt N VIN Hey Board 4rOdu :'a 1,1J'I C._i: l rr: '5 aWa: SL'_iJK.i Model; CL1.100 Color: 3LLE Class: M r,R,--r'TPV _EF7 .SIDE Pmt Kibor Coda Dei riptian Bre Cat Tech NreiQty Total >+ 1_?�4r's-06S'_Ll''?a CLL:';5 F,� f,S: 5'J 175.99 71'_1.-1'16G@J-'!A'( r ;:!`!7',c''f:;. C:�'t•L�.li. ^T T7MG.1 .- 0-._91 _Lli__�:),L,'•_'cn ,./�I f'"! • II•:.•<- -1_P.iit r_cr.+_H ;L' :J ='2,l 74.)3 :)61:1=ter 4 SIE1 d LL 7r::_ SU GvJ r,-ATE, FIL_1[:; SI: �fi'J i G y LL 31541-UG1Z-291 CcviR,KNUC LE,L SU FSU i 1a.33 -LT,1P,,Y.. 1:3: 80 SL PSIJ 9.99 s�'t-L15GI1 LEITR ^--3Y-GEAR Sj PC:1 h3.9? — — _- —CLIP CQ Labor 1 :'A"AGE ESTINI`E 2.N iU.'N =s- Jan 24 08 02: 33p Steven Kittelson 707 538 2999 p. 4 Dania =)5_ >c Santa kosa. LA 55Q SERVICE RE�IR QR�R Saye. _!oh Put 5 Taber joblot tthO W wn I 2,£34'.'5 Igt#1 of III J¢ s',s 14.75 Repair •der Total 3,'93.5. Q v�\ j 1...:,. I Christopher B. Dolan (SBN 165358) Francis J. Shehadeh (SBN , 2 THE DOLAN LAW FIRM 1438 Market Street 3 San Francisco, CA 94102 Tel: (415) 421-2800 4 Fax: (4,15) 421-2830 5 Attorneys for Plaintiff STEVE KITTELSON 6 7 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 IN AND FOR THE COUNTY OF CONTRA COSTA 9 UNLIMITED CIVIL JURISDICTION 10 12 STEVE KITTELSON, 13 Plaintiff; PROOF OF SERVICE 14 V. 15 COUNTY OF CONTRA COSTA 16 Defendant. 17 18 19 20- 23 24 25 26 27 , 2)8 THE •.DOLAN 1 LAW FIRM PROOF OF SERVICE SAN FRANCISCO,CA 94102.. rEL: (415)421:2800 FAX: (415)421-2830 ( t�r:r6 1 PROOF OF SERVICE 3 Kittelson v. County of Contra Costa Superior Court of California, County of Contra Costa 4 .f 5 I, Jill Amy Roaquin, declare that: 6 I am employed in the County of San Francisco, State of California. I am over the age of 18, and am not aTarty to this action. My business address is 1438 Market Street, San Francisco, California 7 941.0. On May , 2008, I served: 8 APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM 9 in said cause addressed as follows: 10 Clerk of the Board of Supervisors 1 l County Administration Building, Room 106 651 Pine Street 12 Martinez, CA 94553 13 (BY CERTIFIED MAIL) By placing a true copy thereof enclosed in a sealed envelope. I 14 placed each such sealed envelope, with postage thereon fully prepaid for first-class mail, for collection.and mailing at San Francisco, California, following ordinary business 15 practices. 16 / / (BY PERSONAL SERVICE) By placing a true copy thereof enclosed in a sealed envelope. I caused each such envelope toe delivered by hand to the addressee(s) noted 17 above. 18 / / (BY PROFESSIONAL MESSENGER SERVICE) By placing and true copy thereof in a sealed envelope, and.causing said envelope to be delivered by professional. messenger 19 service to the addressee(s) listed above. 10 / / (BY FACSIMILE) I caused the said document to be transmitted by facsimile machine to the number indicated atter the addressee(s) noted above. . 21 , (BY FEDERAL EXPRESS) By enclosinT a true copy of the documents in a Federal Express envelope, sealing and deppositing tie envelope, with delivery fees prepaid or provided for, and instructions to deliver overnight, with an office or delivery box regularly 23 maintained by Federal Express in San Francisco, California. 24 .I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on May_,' 2008, at San Francisco, California. 25 26 27 Jill Amy Roaquin 28 THE DOLAN 2 LAW FIRM PROOF OF SERVICE SAN FRANCISCO,CA �4io2 IEL: (415)421-2800 FAX: 1415)421-2830 i i E . 4 02 1A i 00043! ° MAILS Jeal Wit. = 7006 2150 0000 .0454 0657 RECEIVED The Dolan Lase FiT7n JUN 0 2 2008 1 X38 ''yls,rh•et Street CLERK BOARD OF SUPERVISORS San Fr:ancisco, California 94'102 CONTRA COSTA CO. Clerk of the Board of Supervisors County Administration Building, Room 106 651 Pine Street Martinez, CA 94553 y � �o `.•- ' CLAIM BOARD OF SUPERV.I:SO.RS OF CONTRA COSTA COUNTY � BOARD ACTION: Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANTC and Board Action. All Section references are to The copy of this document marled to California Government Codes. Ex you is your notice of the action taken on your claim.by the Board of MAY 19 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL MARTINEZ CALIF Section 913 and 915.4. Please note all AMOUNT: n �Gl MA "Warnings" CLAIMANT: Eyvi O ATTORNEY: nCc DATE RECEIVED: ADDRESS: 1`'t� Jr 5 1� BY DELIVERY TO CLERK ON: 1, _ ,`, t ^I__ BY MAIL POSTMARKED: r1 ICA mezFROM: Clerk of the Board oflSluupervisors T0: County Counsel Attached is a copy of the above-noted claim. JOHN CULLSClerk Dated: IC( xm By: Deputy—t= V VC��L1✓1 • R. FROM.: Co my Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. —� This Claire FAILS to comply substailt.ially with Sections 910 and 910.2, and ;ve are so notifying claimant. The Board cannot act foi' 15 days (Section 910.8). J ( ) Claim is not timely filed. The Clerk should retum claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 5- " y By: /71 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I.V. BOARD ORDER: By unanimous vote of the Supervisors present: ' (V)' This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. f RN CULLEN, CLERK, By eputy Clerk WAR Gov. code section 913) Subject to certain exceptions,you have only six(6) rnontlrs from the date this notice was personalty served or deposited in the mail to Tile a court action on this claim.See Government Code Section 945.6.You may seek the idviee of an attorney of your choice in connection with this matter. I I'you want to consult an attorney,you sliould.do so immediately. *For Additional Warning See Reverse Side of.11is Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1. am now, and at all times herein mentioned, have been a citizen of the United States, over age 1.8; :and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certilied copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: Qt,4 oY, A;�q-d J HN CULLEN, CLERK By eputy Clerk D4 r, - � � 7 From:ASSESSORS OFFICE 925 313 7630 05/23/2008. 14:49 #062 P.002 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �TSTRUCTIONS TO CL-kUVLANT �.. k claim relating to a cause of action for death or for injury• to person or to personal pro'ai or growing crops shall be presented not later than six.months after the accrual of the cause of action. A claim relating to any other cause ofaction shall be presented not later than one }rear after the accrual of the cause of action. .(Gov. Code § 911.2.) 3. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. �. If the claim is against more than one public entity, separate claims must be filed against each.. public entity. ., Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this.form. R R■■ ■[!ME am a a a sons it a k a■No a k ■R■■R=a■f R k■R a■■k a a Y Y■w t :E: Claim By. Reserved for Clerk's filing stamp LIN 12,00 6 RECEIVED MAY 1 5 2008 �gainst the Cotunty of Contra Costa or ) CLE BOAR Or suP S CONTRA CO3TA CO. N n2 A Gn 5T-A' District) Fill is the name) X he undersigned claimant hereby makes claim against the County of Contra Costa or the above-named i.L--trict in the sum of$ and in support of this claim represents as follows: When did the damage or injury occur? (Give exact data and hour) /Vl,ci rrih '7,i, ,,"F !; 3 L PM Where did the damage or injury occur? (Include city and county) n� IISSESSa�� OFFi� PAi2i`1 &Cr Lv i �a AKKVLD at , n 2T7N1e2 How did the damage or injury occur? ..(Give full details;use extra paper if mquimd) �5 /V,4/>I n I -J L4/-1 A K t; Sl 0 0 4 tle7b µ4.I C-A;-, t4,,Hi LS A T7ZFP-f 1"71 A � %at'particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? What are the names of couaty or district officers, servants, or employees causing the damage or injury? From:ASSES'e0RS OFFICE 925 313 7630 05/23/2003 14:50 #062 P.003 6. 'Wli t dmnage or injuries do your claim resulted? (Give full extent of injuries or damages claimed, Attacb.two estimaws for auto damage.) 1;57?M A 7. dour was the amount ela-aed above cormp ntd? (Include the estimated a��ouut of any prospecuiTe injury or damage.) �. Names.and addresses of witnesses, doctors, and hospitals: ' 9. List the expenditures you m.*de on account of this accident or injury: DATE TnVM AMOUNT ■ R a e a&wit a e R a a a a a z e R a[■■a K a>t■R 19 a a R a a[a a[a a a[a t a a a a 0 t t■■A a a R a a a l a a a a 9 a a a a t■a R R 14 t a a a r .Gov,.Code Sec. 910.2 provides "The claim shall be zed by the claimant or.by some person on.his �ontra Emilyn Russo -..o toi Auditor•Appraiser _...0 n`y Phone (925)313-7600 V-Ice Z- Fax# (925)313-7530 (Claimignt's Signature) E-Mail: eruesQessr.crcounty.us �^ � •� Assassor's O;fiCe 2530 Arnold Drive, Sufte 400 Martlnsz,CA 94553.4359 (Address) Telephone No. ) Telephone No. 6 -0 g 8 ■R■1K I M d k a h a a a a a 2 a a a a a a[ a a a Ka R a s an a l a s[a[Rsaaa[a ta r l t Y Y t R a a R RRa[aRaa[a aaa am a 5[aaa[a111 PUBLIC RECORDS NOTICE. P}case be advised that this claim form,�or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Rxords Act. (Gov. Cod:,, 55 6500 .et seq.) Furthermore, any attachments;addeudu a&, or supplem.a;p attached to the claim form, including medical records, are also subject to public disclosure. >t a a![ a f a a a[■ a■R a[[f a a t 1 a a 7 ■RVIKINES a a a V■[a e a a RERRE■a a a a a a SEE ONE NURSER a a[ a on a a a■a a R t R R a t NOTICE: Section 71 of the Penal Code provides.,. Every person who, with intent to defraud, presents for allowance or for .payment to any state board or of icer, or s .to azy county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent.claim, bill, account voucher, or writing, is punishable either by imprisonment in the County:jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000,00), or by both such imprisonment and nae, or by impriso=mt in the state prison,by a fizzle of pot exceeding ten thousand dollars ($10,000), or by both such imprisozunent and fine. From:ASSESSORS- OFFICE 925 313 7630 05/23/2008 14:49 #062 P.001 FACSIMILE COVER PAGE DATE: S 2 3 f V K TO. FAX NO: FROM: Contra Costa rounty Assessor's Office 2530 Arnold Drive, Sulte'400 Martinez, CA 94553-4359 FAX No: 825-393 -7830 NUMBER OF PAGES TO FOLLOW:. `3 (excluding cover page) MESSAGE: Sal IF THERE IS A TRANSMISSION PROBLEM, PLEASE CALL FAX OPERATOR. (925) 393-780.0 G:IDATA%FORMSIOFF)Ct=WDM 408D-C Rev. 02/21/01 r AMENllF,U CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION:: Claim Against the County, or District Governed by ) the .Boa.rcl of St.ipeivisors, .Routing .E_ndorsen►eilts, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailel California. Government. Codes. ) you is your notice of the action to i D on your claim by the Board of Civ Supervisors. (Paragraph IV below), given Pursuant to Government Code JUL 0`31008 Section 913 and 915.4. Please note all ANIOUNT: Y1 a COUNTY OOUNSEL "`'earnings". MARTINEZ CALIF CLAINIANT: ' ZE�m Ly AJ ieUWS 7 A'171'0IZNEY: DATE RECEIVED: ADDRESS: �� SS��Sp�O BY DELIVERY 1'O CLERK ON:� /a�-� BY 1V1.AIL POSTMARKED: FROM.: Clerk of the l3oaicl of Supetvtsors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN t Dated: 3d z By: Depu II. FRON: County Counsel TO: Clerk of the Board of Supmis rs ( "Chis claim complies substantially with Sections 9.10 and 910.2. ( ) "Chis Claint [AILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 clays (Section 910.8). . O Claim is not timely (fled. -File Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91 1.,.3). --- Dated: - / �- D By: "' Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: Ry unanimous vote of the Supervisors present. (r This Claim is rejected in.full. O Other: _ I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. llatec . m9HN CU.LLEN, CLERI{, By _ Deputy Clerk WA.R . NC (Gov. code section 91 j SubJecl to certain exceptious,you have only six(6)months from the date this uotice was personally served or deposited in the mail to file a court action on Ihis claim.See Government Code Section 945.6.You may seek the advice of an attorney of,your clmice in connection with this matter. If you want to consult an attorney,you sitotilti tlo so imrrreciiately. *f or Addil.ional Wai-iung See Reverse Side of Dais.Not.ice. AFFIDAVIT OF MAILING I declare tiller pedally oh peg jure that I ant now, mill at all limes herein mentioned, have been a citizen of life United Slates, over age l8; alld that today 1 deposited ill the United States 1'ostal Service ill kht-tinez, California, postage fully prepaid a certified copy ofthis Boaud Order and Notice to Ctainta.nt, addressed to (lie claimant as shown above. Dated) __ _ 9..�� IL►I-iN C'lJI_I-.L.N, !:'1..1=1Z1{ 13V _ , . e}?uty Clerk Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925) 335-1800 Martinez, CA 94553 Facsimile: (925) 335-1866 Writer's Direct Dial: (925)335-1885 Date: May 27, 2008 To: Jane Pennington, Chief Clerk Clerk of the Board of Supervisors From: Monika L. Cooper, Deputy County Counsel rYl Re: Amended Claim of Emilyn Russo Please process the.attached claim of Emilyn Russo as an Amended Claim. Thank you for your assistnce with this matter. Please call with any questions. M A`( 2 � 100a C r�FVIS�HS Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925) 335-1800 Martinez, CA 94553 Facsimile: (925)335-1866 Writer's Direct Dial: (925) 335-1885 Date: May 27, 2008 To: Jane Pennington, Chief Clerk Clerk of the Board of Supervisors From: Monika L. Cooper, Deputy County Counsel rYl Re: Amended Claim of Emilyn Russo Please process the attached claim of Emilyn Russo as an Amended Claim. Thank you for your assistance with this matter. Please call with any questions. • I 'From:ASSESSORS OFFICE 925 313 7630 05/23/2008 14:49 #062 P.002 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY OSTFUCTIONS TO CL4IlYIANT A. A. claim relating to a cause of action for death or for injury to person or to personal propart3'or growing crops shall be presented not later than six months after the accrual of the cause of action, A claim relating to any other cause ofaction shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the naive of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each. public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. a■■■ ■ a 1 f■1111110 OEM ma■Y Is■■a■■R=■■■A R■A■ ■■R■ ■■■■■•■Exam KEEMER■■t R■■■■■■■1■■ ■■us RE: Claim By: Reserved for Clerk's filling stamp j�IVI I L,YtiJ 12"o 5 a RECEI QED MAY 1 5 2008 Against the County of Contra Costa or j CES eoA OOF Eur s �+ COtiTRAC_ Co. W M Tyr `t CC'5 District) (Fill iu the name). Y The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) l�'let rGG. `1�r9-v 1 : 3 L P/vl 2. Where did the damage or injury occur? (Include city and county) (!,NN'-MA ws n �s3G, 1*AffVL9 zdZ M'1�2r7aJEZ 3. How did the damage or injury occur? (Give full details;use ex-tra paper if required) n'15 lel �>�nl .JUM�3/�� r�'I D� hwir'Eb µmf Grp !�.'l4,rc.G ATTER-iPn�C� /d 4. 'What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 5 What are the names of county or district officers, servants, or employees causing the damage or i.ajury? `rrom:ASSESSORS OFFICE 925 313 7630 05/23/2008 14:50 #062 P.003 6. VW`,eL dm-nage or injuries do your, claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above coanputed? (Include the estimated as�ouut of any prospective injury or damage,) S. Names and addresses of Aritnesses, doctors, and hospitals: 9. List the expenditures you n*. e on account of this accident or injury: DATE TWE AMOUNT F A a a r r a r a a a a a a a a a a a a t a a a a t a■■aa area taraaasaasaaaass■■■rraraaaeaaas■ss aas a aaaa■r■ramal .Gov. Code Sec. 910.2 providers"The claim shall be ied by the claimant or by some person on.his Contra Emilyn Russo Co to Auditor-Appraiser Co my Phone (925)313-7600 ?t'rG 2� Fax# (925)313-7530 (Claba=t's Signature} ' E-Mail: eruesCassr.cccounty.us iru� I< Assessor's OffiCe 1�r,•:= 2530 Arnold Drive,Suite 400 Msrtlnez,CA 94553-4359 (Address) . ��.... ) Telephone No. )Telephone No, 7 D ' Z s 0 3 g 8 ■at arr■arahaaa■moss amaana■■a'aman assaataaataalaatmanna rraalfaa■laaman taaaanaamaman aaaal PUBLIC RECORDS NOTICE: Please be advised that this claim form, or amy claim filed with the County under the Tort Claims Act, is subject to public disclosure under the Califorrda Public Records Act. (Gov. Code, 55 .6500 .t-t seq.) Furthermore, any attaclunents, addendunms, or supplemepp attached to the.claim form, including medical records, are also subject to public disclosure, ■t I a a a f a a a a a t a a t a a a a Emma No■a a r a t a a r a Y a a a a a a Rages am MMEERREM Ion MEMMEM ata SEEN a■ata F a a F f 1 NOTICE: .Section 72 of the Penal Code provides.. Every person who, with intent to defraud, presents for allowance or for'payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County,fail for a period of not wore than one year,.by a fine of not exceeding one thousand dollars ($1,000,00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of riot exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. 'From:ASSESSORS OFFICE 925 313 7630 . 05/23/2008 14:49 #062 P.001 FACSIMILE COVER PAGE DATE: TO: FAX NO: .FROM: I�vzSSl� Contra Costa County Assessor's Office - '- 2530 Arnold Drive, Suits 400 Martinez, CA 94553-4359 FAX No: 925 - 313 -7630 NUMBER OF PAGES TO FOLLOW: `3 (excluding cover page) MESSAGE: _I - 4 I VY v r IF THERE IS A TRANSMISSION PROBLEM, PLEASE CALL FAX OPERATOR: (925) 313-7600 G.\DATA\FORM=FFICE\ADM 4080-C Rev. 02/21/01