Form Disc 004 PDF Details

Form Disc 004 is an important form that you will need to complete if you are starting a new business. This form can be used to register your company with the government and obtain tax identification numbers for your business. Completing this form accurately will help ensure that your business is compliant with all state and federal regulations. Be sure to consult with an accountant or lawyer before filing this form, as there may be specific requirements that vary depending on your business type.

QuestionAnswer
Form NameForm Disc 004
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesform interrogatories limited, E-MAIL, typewriting, DISC-004

Form Preview Example

DISC-004

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

TELEPHONE NO.:

FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

SHORT TITLE:

FORM INTERROGATORIES—LIMITED CIVIL CASES (Economic Litigation)

Asking Party:

Answering Party:

Set No.:

CASE NUMBER:

Sec. 1. Instructions to All Parties

 

 

 

 

(b)

As a general rule, within

30 days after you are served with

 

 

 

 

 

 

 

 

 

 

(a)

Interrogatories are written questions prepared by a party to

 

these interrogatories, you must serve your responses on the

 

an action that are sent to any other party in the action to be

 

asking party and serve copies of your responses on all other

 

answered under oath. The

interrogatories below are form

 

parties who have appeared. See Code

of Civil Procedure

 

interrogatories approved for use in economic litigation.

 

sections 2030.260–2030.270 for details.

 

 

(b) For time limitations,

requirements for

service

on other

(c)

Each

answer must be as complete and straight-forward as

 

parties, and other details, see Code

of Civil

Procedure

 

the information reasonably available to you permits. If an

 

sections 2030.010–2030.410 and the cases construing those

 

interrogatory cannot be answered completely, answer

it to

 

sections.

 

 

 

 

 

 

 

 

the extent possible.

 

 

 

 

(c)

These

form

interrogatories

do

not

change existing law

(d)

If

you do not have enough personal

knowledge to

fully

 

relating to

interrogatories,

nor

do they affect an answering

 

 

answer an interrogatory, say so, but make a reasonable and

 

party's right to assert any privilege or make any objection.

 

 

 

good

faith effort to get

the information by asking other

 

 

 

 

 

 

 

 

 

 

 

Sec. 2. Instructions to the Asking Party

 

 

 

 

persons or

organizations, unless the information is equally

(a)

These

interrogatories

are

designed

for optional use by

 

available to the asking party.

 

 

 

 

parties

under economic litigation in limited civil cases. See

(e) Whenever an interrogatory may be answered by referring to

 

Code of Civil Procedure sections 90 through 100. However,

 

a document, the document may be attached as an exhibit to

 

these interrogatories also may be used in unlimited civil

 

the response and referred to in the response. If the

 

cases.

 

 

 

 

 

 

 

 

 

document has more than one page, refer to the page and

(b)

There are restrictions on discovery

for most limited civil

 

section where the answer to the interrogatory can be found.

 

cases. These restrictions limit the number of interrogatories

(f)

Whenever an address and telephone number for the same

 

that may be asked. For details, read Code of Civil

 

 

person are

requested in

more than one interrogatory, you

 

Procedure section 94.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

are required to furnish

them in answering only the first

 

 

 

 

 

 

 

 

 

 

 

(c) Some of these interrogatories are similar to questions in the

 

interrogatory asking for that information.

 

 

 

Case Questionnaire for Limited Civil Cases (form DISC-010)

(g)

Your

answers

to these

interrogatories must be verified,

 

and may be omitted if the information

sought has already

 

 

dated, and signed. You may wish to use the following form

 

been provided in a completed Case Questionnaire.

 

 

 

at the end of your answers:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(d)

Check

the

box next to each interrogatory that you want the

 

I

declare under

penalty

of perjury

under the laws of the

 

answering party to answer. Use care in choosing those

State

of

California

that the

foregoing

answers are true

and

 

interrogatories that apply to the case and are within the

correct.

 

 

 

 

 

 

 

 

 

 

restrictions discussed above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(e)

You may insert your own definition of

INCIDENT in Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(DATE)

 

 

 

 

 

(SIGNATURE)

 

 

4, but only where the action arises from a course of conduct

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or a series of events occurring over a period of time.

Sec. 4. Definitions

 

 

 

 

 

 

 

(f)

The interrogatories in

section 116.0,

Defendant's Conten-

 

Words in BOLDFACE CAPITALS in these interrogatories

 

 

 

 

 

 

 

 

 

 

 

 

tions - Personal Injury, should

not be used until defendant

are defined as follows:

 

 

 

 

 

has had a reasonable opportunity to conduct an

 

 

(Check one of the following):

 

 

 

 

investigation or discovery of plaintiff's injuries and damages.

 

(a)

(1)

INCIDENT includes the

circumstances

and

(g)

Additional interrogatories may

be attached, subject to the

 

 

 

 

events surrounding the alleged

accident, injury, or

 

restrictions discussed above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

other

occurrence

or breach of contract giving rise to

Sec. 3. Instructions to the Answering Party

 

 

 

 

 

 

 

 

this action or proceeding.

 

 

 

(a) Subject to

the restrictions discussed above, you must

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

answer or provide another appropriate response to each

 

 

 

 

 

 

 

 

 

 

 

 

 

interrogatory that has been checked below.

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Approved for Optional Use Judicial

FORM INTERROGATORIES – LIMITED CIVIL CASES

 

Code of Civil Procedure, §§ 94,

 

Council of California

 

 

 

2030.010-2030.410, 2033.710

 

 

 

 

 

 

(Economic Litigation)

 

 

 

 

 

 

 

 

DISC-004 [Rev. January 1, 2007]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WWW.ACCESSLAW.COM

(2) INCIDENT means (insert your definition here or on a separate, attached sheet labeled "Sec. 4(a) (2)"):

(b)YOU OR ANYONE ACTING ON YOUR BEHALF includes you, your agents, your employees, your insurance companies, their agents, their employees, your attorneys, your accountants, your investigators, and anyone else acting on your behalf.

(c)PERSON includes a natural person, firm, association, organization, partnership, business, trust, corporation, or public entity.

(d)DOCUMENT means a writing, as defined in Evidence Code section 250, and includes the original or a copy of hand- writing, typewriting, printing, photostating, photographing, electronically stored information, and every other means of recording upon any tangible thing and form of communicating or representation, including letters, words, pictures, sounds, or symbols, or combinations of them.

(e)HEALTH CARE PROVIDER includes any PERSON referred to in Code of Civil Procedure section 667.7(e)(3).

(f)ADDRESS means the street address, including the city, state, and zip code.

Sec. 5. Interrogatories

The following interrogatories have been approved by the Judicial Council under Code of Civil Procedure section 2033.710:

CONTENTS

101.0Identity of Persons Answering These Interrogatories

102.0General Background Information - Individual

103.0General Background Information - Business Entity

104.0Insurance

105.0[Reserved]

106.0Physical, Mental, or Emotional Injuries

107.0Property Damage

108.0Loss of Income or Earning Capacity

109.0Other Damages

110.0Medical History

111.0Other Claims and Previous Claims

112.0Investigation - General

113.0[Reserved]

114.0Statutory or Regulatory Violations

115.0Claims and Defenses

116.0Defendant's Contentions - Personal Injury

117.0[Reserved]

120.0How the Incident Occurred - Motor Vehicle

125.0[Reserved]

130.0[Reserved]

135.0[Reserved]

150.0Contract

160.0[Reserved]

170.0[Reserved]

101.0Identity of Persons Answering These Interrogatories

101.1 State the name, ADDRESS, telephone number, and relationship to you of each PERSON who prepared or assisted in the preparation of the responses to these interrogatories. (Do not identify anyone who simply typed or reproduced the responses.)

DISC-004

102.0 General Background Information - Individual

102.1 State your name, any other names by which you have been known, and your ADDRESS.

102.2 State the date and place of your birth.

102.3State, as of the time of the INCIDENT, your driver's license number, the state of issuance, the expiration date, and any restrictions.

102.4 State each residence ADDRESS for the last five years and the dates you lived at each ADDRESS.

102.5 State the name, ADDRESS, and telephone number of each employer you have had over the past five years and the dates you worked for each.

102.6 Describe your work for each employer you have had over the past five years.

102.7 State the name and ADDRESS of each academic or vocational school you have attended, beginning with high school, and the dates you attended each.

102.8 If you have ever been convicted of a felony, state, for each, the offense, the date and place of conviction, and the court and case number.

102.9 State the name, ADDRESS, and telephone number of any PERSON for whom you were acting as an agent or employee at the time of the INCIDENT.

102.10 Describe any physical, emotional, or mental disability or condition that you had that may have contributed to the occurrence of the INCIDENT.

102.11 Describe the nature and quantity of any alcoholic beverage, marijuana, or other drug or medication of any kind that you used within 24 hours before the INCIDENT.

103.0 General Background Information - Business Entity

103.1 State your current business name and ADDRESS, type of business entity, and your title.

104.0 Insurance

104.1 State the name and ADDRESS of each insurance company and the policy number and policy limits of each policy that may cover you, in whole or in part, for the damages related to the INCIDENT.

105.0[Reserved]

106.0 Physical, Mental, or Emotional Injuries

106.1 Describe each injury or illness related to the

INCIDENT.

106.2 Describe your present complaints about each injury or illness related to the INCIDENT.

106.3 State the name, ADDRESS, and telephone number of each HEALTH CARE PROVIDER who treated or examined you for each injury or illness related to the INCIDENT and the dates of treatment or examination.

DISC-004 [Rev. January 1, 2007]

FORM INTERROGATORIES–LIMITED CIVIL CASES

(Economic Litigation)

Page 2 of 4

106.4 State the type of treatment or examination given to you by each HEALTH CARE PROVIDER for each injury or illness related to the INCIDENT.

106.5 State the charges made by each HEALTH CARE PROVIDER for each injury or illness related to the

INCIDENT.

106.6 State the nature and cost of each health care service related to the INCIDENT not previously listed (for example, medication, ambulance, nursing, prosthetics).

106.7 State the nature and cost of the health care services you anticipate in the future as a result of the INCIDENT.

106.8 State the name and ADDRESS of each HEALTH CARE PROVIDER who has advised you that you may need future health care services as a result of the INCIDENT.

107.0 Property Damage

107.1 Itemize your property damage and, for each item, state the amount or attach an itemized bill or estimate.

108.0 Loss of Income or Earning Capacity

108.1 State the name and ADDRESS of each employer or other source of the earnings or income you have lost as a result of the INCIDENT.

108.2 Show how you compute the earnings or income you have lost, from each employer or other source, as a result of the INCIDENT.

108.3 State the name and ADDRESS of each employer or other source of the earnings or income you expect to lose in the future as a result of the INCIDENT.

108.4 Show how you compute the earnings or income you expect to lose in the future, from each employer or other source, as the result of the INCIDENT.

109.0 Other Damages

109.1 Describe each other item of damage or cost that you attribute to the INCIDENT, stating the dates of occurrence and the amount.

110.0 Medical History

110.1 Describe and give the date of each complaint or injury, whether occurring before or after INCIDENT, that involved the same part of your body claimed to have been injured in the INCIDENT.

110.2 State the name, ADDRESS, and telephone number of each HEALTH CARE PROVIDER who examined or treated you for each injury or complaint, whether occurring before or after the INCIDENT, that involved the same part of your body claimed to have been injured in the INCIDENT and the dates of examination or treatment.

DISC-004

111.0 Other Claims and Previous Claims

111.1 Identify each personal injury claim that YOU OR ANYONE ACTING ON YOUR BEHALF have made within the past ten years and the dates.

111.2 State the case name, court, and case number of each personal injury action or claim filed by YOU OR ANYONE ACTING ON YOUR BEHALF within the past ten years.

112.0 Investigation - General

112.1 State the name, ADDRESS, and telephone number of each individual who has knowledge of facts relating to the INCIDENT, and specify his or her area of knowledge.

112.2 State the name, ADDRESS, and telephone number of each individual who gave a written or recorded statement relating to the INCIDENT and the date of the statement.

112.3 State the name, ADDRESS, and telephone number of each PERSON who has the original or a copy of a written or recorded statement relating to the INCIDENT.

112.4 Identify each document or photograph that describes or depicts any place, object, or individual concerning the INCIDENT or plaintiff's injuries, or attach a copy. (if you do not attach a copy, state the name, ADDRESS, and telephone number of each PERSON who had the original document or photograph or a copy.)

112.5 Identify each other item of physical evidence that shows how the INCIDENT occurred or the nature or extent of plaintiff's injuries, and state the location of each item, and the name, ADDRESS, and telephone number of each PERSON who has it.

113.0[Reserved]

114.0 Statutory or Regulatory Violations

114.1 If you contend that any PERSON involved in the INCIDENT violated any statute, ordinance, or regulation and that the violation was a cause of the INCIDENT, identify each PERSON and the statute, ordinance, or regulation.

115.0 Claims and Defenses

115.1 State in detail the facts upon which you base your claims that the PERSON asking this interrogatory is responsible for your damages.

115.2 State in detail the facts upon which you base your contention that you are not responsible, in whole or in part, for plaintiff's damages.

115.3 State the name, ADDRESS, and the telephone number of each PERSON, other than the PERSON asking this interrogatory, who is responsible, in whole or in part, for damages claimed in this action.

DISC-004 [Rev. January 1, 2007]

FORM INTERROGATORIES–LIMITED CIVIL CASES

(Economic Litigation)

Page 3 of 4

116.0 Defendant's Contentions - Personal Injury

[See Instruction 2(f)]

116.1 If you contend that any PERSON, other than you or plaintiff, contributed to the occurrence of the INCIDENT or the injuries or damages claimed by plaintiff, state the name, ADDRESS, and telephone number of each individual who has knowledge of the facts upon which you base your contention.

116.2 If you contend that plaintiff was not injured in the INCIDENT, state the name, ADDRESS, and telephone number of each individual who has knowledge of the facts upon which you base your contention.

116.3 If you contend that the injuries or the extent of the injuries claimed by plaintiff were not caused by the INCIDENT, state the name, ADDRESS, and telephone number of each individual who has knowledge of the facts upon which you base your contention.

116.4 If you contend that any of the services furnished by any HEALTH CARE PROVIDER were not related to the INCIDENT, state the name, ADDRESS, and telephone number of each individual who has knowledge of the facts upon which you base your contention.

116.5 If you contend that any of the costs of services furnished by any HEALTH CARE PROVIDER were unreasonable, identify each service that you dispute, the cost, and the HEALTH CARE PROVIDER.

116.6 If you contend that any part of the loss of earnings or income claimed by plaintiff was unreasonable, identify each part of the loss that you dispute and each source of the income or earnings.

116.7 If you contend that any of the property damage claimed by plaintiff was not caused by the INCIDENT, identify each item of property damage that you dispute.

116.8 If you contend that any of the costs of repairing the property damage claimed by plaintiff were unreasonable, identify each cost item that you dispute.

11 6.9 If you contend that, within the last ten years, plaintiff made a claim for personal injuries that are related to the injuries claimed in the INCIDENT, identify each related injury and the date.

116.10 If you contend that, within the past ten years, plaintiff made a claim for personal injuries that are related to the injuries claimed in the INCIDENT, state the name, court, and case number of each action filed.

117.0[Reserved]

120.0How the Incident Occurred - Motor Vehicle

120.1 State how the INCIDENT occurred.

120.2 For each vehicle involved in the INCIDENT, state the year, make, model, and license number.

120.3 For each vehicle involved in the INCIDENT, state the name, ADDRESS, and telephone number of the driver.

DISC-004

120.4 For each vehicle involved in the INCIDENT, state the name, ADDRESS, and telephone number of each occupant other than the driver.

120.5For each vehicle involved in the INCIDENT, state the name, ADDRESS, and telephone number of each regis- tered owner.

120.6 For each vehicle involved in the INCIDENT, state the name, ADDRESS, and telephone number of each lessee.

120.7 For each vehicle involved in the INCIDENT, state the name, ADDRESS, and telephone number of each owner other than the registered owner or lien holder.

120.8 For each vehicle involved in the INCIDENT, state the name of each owner who gave permission or consent to the driver to operate the vehicle.

150.0 Contract

150.1 Identify all DOCUMENTS that are part of the agreement and for each state the name, ADDRESS, and telephone number of the PERSON who has each DOCU-

MENT.

150.2 State each part of the agreement not in writing, the name, ADDRESS, and telephone number of each PERSON agreeing to that provision, and the date that part of the agreement was made.

150.3 Identify all DOCUMENTS that evidence each part of the agreement not in writing, and for each state the name, ADDRESS, and telephone number of the PERSON who has each DOCUMENT.

150.4 Identify all DOCUMENTS that are part of each mod- ification to the agreement, and for each state the name ADDRESS, and telephone number of the PERSON who has each DOCUMENT.

150.5 State each modification not in writing, the date, and the name, ADDRESS, and telephone number of the PERSON agreeing to the modification, and the date the modification was made.

150.6 Identify all DOCUMENTS that evidence each modification of the agreement not in writing and for each state the name, ADDRESS, and telephone number of the PERSON who has each DOCUMENT.

150.7 Describe and give the date of every act or omission that you claim is a breach of the agreement.

150.8 Identify each agreement excused and state why per- formance was excused.

150.9 Identify each agreement terminated by mutual agree- ment and state why it was terminated, including dates.

150.10 Identify each unenforceable agreement and state the facts upon which your answer is based.

150.11 Identify each ambiguous agreement and state the facts upon which your answer is based.

DISC-004 [Rev. January 1, 2007]

FORM INTERROGATORIES–LIMITED CIVIL CASES

(Economic Litigation)

Page 4 of 4

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1. The typewriting involves particular details to be inserted. Ensure that the subsequent blanks are completed:

Find out how to fill in photostating step 1

2. Just after finishing the last step, go on to the next stage and fill out the necessary details in these blanks - d Check the box next to each, e You may insert your own, f The interrogatories in section, I declare under penalty of perjury, DATE, SIGNATURE, Sec Definitions, Words in BOLDFACE CAPITALS in, are defined as follows, Check one of the following, INCIDENT includes the, Form Approved for Optional Use, Council of California, DISC Rev January, and FORM INTERROGATORIES LIMITED.

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3. The next step is hassle-free - fill in every one of the blanks in INCIDENT means insert your, b YOU OR ANYONE ACTING ON YOUR, General Background Information, State your name any other names, DISC, State the date and place of your, State as of the time of the, State each residence ADDRESS for, c PERSON includes a natural person, State the name ADDRESS and, d DOCUMENT means a writing as, e HEALTH CARE PROVIDER includes, f ADDRESS means the street address, Sec Interrogatories, and Describe your work for each to conclude this segment.

photostating conclusion process described (stage 3)

It's easy to make errors while completing the State the date and place of your, so make sure to go through it again before you'll finalize the form.

4. Your next subsection requires your information in the subsequent places: Judicial Council under Code of, CONTENTS, Identity of Persons Answering, Describe any physical emotional, Describe the nature and quantity, General Background Information, State your current business name, Insurance, State the name and ADDRESS of, Reserved Physical Mental or, Describe each injury or illness, and Describe your present complaints. Make certain to provide all required info to go onward.

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5. This form should be wrapped up by filling in this part. Here you will notice a comprehensive list of blank fields that need to be filled out with accurate information for your form usage to be complete: Identity of Persons Answering, State the name ADDRESS telephone, Describe your present complaints, State the name ADDRESS and, DISC Rev January, FORM INTERROGATORIESLIMITED CIVIL, Page of, and Economic Litigation.

Stage number 5 of filling out photostating

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