CITY CLERK'S DATE STAMP
CITY OF RIALTO
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2024 JUN 27 AM10: 56
1. Claims for death, injury to person, or to personal property must be fled not later than six (6) months atter the occurrence (GoV. Code 591 ITY CLERK RECEITED
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:
3. READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office
4.ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Nancy Fricks
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FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Gregory Peacock, Law Office of Gregory Peacock; 4063 Birch Street,
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
Suite 100, Newport Beach, CA 92660.
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: December 25, 2023 TIME: Early morning
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks.
3. HOW DID DAMAGE OR INJURY OCCUR?
On December 25, 2023, various Rialto Police Department officers, including Martinez and Schepp, unlawfully entered and searched Claimant's home, Tocated at The involved Rialto Police Department officers, including Martinez and Schepp atso untawfulty _destroyed Claimant's real and personal property
4. WERE POLICE AT THE SCENE? × YES • NO WERE PARAMEDICS AT THE SCENE? • YES IX NO
5. WHAT PARTICULAR ACT OR C: SSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
Various Rialto Police Department Officers, including but not limited to Officers Martinez and Schepp, unlawfully entered and searched Claimants home. The involved Rialto Police Department Officers also unlawfully destroyed Claimant's real and personal property
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ In excess of $25,000 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
General and Special Damages; emotional distress pain and sufferingAmount: $ In excess of $25,000 Item/Date: Loss of Real and personal property; Punitive damages Item/Date: Amount: $ In excess of $25,000
In excess of $25,000
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Genera Specialdunges,;including loss at renlt Amount: $_In excess of $25,000 Item/Date: Personal proporty; emotinal ditress Amount: $ In excess of $25,000
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: | ) TELEPHONE: |)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: TELEPHONE: )
DATE: _ TIME: DAM LIPM DATE: TIME: •AM 0 PM
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate place of accident by "X" and by showing house numbers or distances to street corners.
If a city/town vehicle was involved, designate by letter "A" location of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehicle when you first saw City/Town vehicle; location of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of the accident by "B-1" and the point of impact by "X".
→ NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.
CURB
PARKWAY
2024 JUN 27
SIDEWALK
- CITY GLER RECEITE
AM
I HAVE READ THE FORGOING CLAIM AND KNOW THE CONTENTS THEREOF: AND CERTIFY THAT THE SAME IS TRUE OF MY OWNKNOWLEDGE EXCEPT AS TO TERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF: AND AS TO THOSE MATTERS I BELIEVE THEN TO BRTRUE.
CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAMTANT OR AGENT
Gregory Peacock June 24, 2024
TYPE OR PRINT NAME DATE
Lawyer
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376
PROOF OF SERVICE CITY OF RIALTO
1 2024 JUN 27 AM IO: 57
2 STATE OF CALIFORNIA, COUNTY OF ORANGE
RECEIVEL
3 I, the undersigned, hereby certify that I am a citizen of the United States Calliover the age of 4 eighteen; I work in the County of Orange, California, in which County the within mailing took place; and I am not a party to the subject case. My business address 4063 Birch Street, Suite 100, 5 Newport Beach, CA 92660.
6 I am familiar with the practice of this law firm for the collection and processing of documents 7 for mailing with the United States Postal Service, that the documents would be deposited with the United States Postal Service that same day in the ordinary course of business. 8 9 On March 9, 1970, I placed the within documents) described as:
10 NANCY FRICK'S CLAIM FOR DAMAGES TO CITY OF RIALTO
11 D BY MAIL: I am "readily familiar" with the firm's practice of collecting and processing 12 correspondence for mailing. Under that practice it would be deposited with the U.S. postal service on that same day with postage thereon full prepaid at Whittier, California, in the ordinary course 13 of business. I am aware that on motion of the party served, service is presumed invalid if postal 14 cancellation date or postage meter date is more than one day after date of deposit for mailing in affidavit.
15 VIA FACSIMILE TRANSMISSION: I caused the above-described documents) to be 16 transmitted to the ottices of the interested parties at the tacsimile numbers) indicated on the 17 attached Service List and the activity reports) generated by facsimile number (800) 644-9861 indicated all pages were transmitted.
18 19 Executed on March 9, 1970, at Newport Beach, California 9266 20 21
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CITY OF RIALTO
SERVICE LIST
1 2024 JUN 27 AM IO: 57
2 RIALTO CITY CLERK'S OFFICE
RECEIVED
150 S. PALM AVE. CITY CLERK
3 RIALTO, CA 92376
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92375-548799
Rialto CA 92376
150 S. Palm Ave CITY CLERK RECEIYED 2024 JUN 27 AM10: 57 CITY OF RIALTO Rialto city Clerk's Office
9589 0710 5270 0690 2591 12
S88078.176
FROM 92660 Newport Beach, CA 92660
062S0014230475 4063 Birch St. Suite 100
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