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[Attorney name]
[Address]
[Telephone number]

Attorney for Petitioner, [name]

_ _ _ _ _ _ Court, County of _ _ _ _ _ _
[_ _ _ _ _ _ District]

_ _ _ _ _ _ _ _ _ _ _ _ _ ) No. _ _ _ _ _ _
Petitioner )
v. ) PETITION FOR LEAVE TO FILE CIVIL
) ACTION AGAINST PUBLIC ENTITY
_ _ _ _ _ _ _ _ _ _ _ _ _ ) (Govt C 946.6)
Respondent ) [POINTS AND AUTHORITIES;
____________________________) DECLARATION(S)]
Hearing: [date; time]
Department: _ _ _ _ _ _
[Estimated length:_ _]

[Name] declares:

1. Claimant, [name], petitions the Court for an order permitting [her/him/it] to commence and pursue a civil action against respondent, [name of entity].

2. On [date cause of action accrued], claimant acquired causes of action against respondent under the circumstances described in the attached claim, a copy of which, marked Exhibit _ _, is incorporated in this petition.

3. On [date late claim application was presented to entity], claimant presented to respondent, by [means by which application was made], the attached claim and the attached application for leave to present late claim, a copy of which, marked Exhibit _ _, is incorporated in this petition. This application was denied by respondent on [date], by [e.g., notice of rejection dated [specify]/failure to act on the claim or the application].

4. The grounds for issuance of the order sought by this petition are: [Specify grounds].

5. [Continue declarant's statements].

This petition is based on the attached documents and exhibits including [specify any not already described by title and date, e.g., the declaration of [name], dated [specify], and on any evidence received at the hearing].

I declare under penalty of perjury under the laws of the State of ___________ that the foregoing is true and correct.

Date: _ _ _ _ _ _ [Signature]
____________
[Typed name]
Attorney for _ _ _ _ _ _ _

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