Complaint for Damages

State Bar No:

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Attorney for

SUPERIOR COURT OF THE STATE OF CALIFORNIA

COUNTY OF

COMPLAINT FOR DAMAGES

(Wrongful Death)

Plaintiff complains and for causes of action alleges as follows:

FIRST COUNT

(Negligence)

I. The only surviving heirs of [name], deceased (referred to in this complaint as "decedent"), are:

II. Plaintiffs are the surviving heirs at law of the decedent. [Plaintiff is the surviving spouse of the decedent and plaintiff is the surviving minor child of decedent.]

III. [Add if applicable: was duly appointed guardian ad litem of plaintiff on by order of this court. A copy of the order is attached and incorporated by reference.]

IV. [Add if applicable: ]

V. Plaintiffs do not know the true names of defendants DOES 1 through 50, inclusive, and therefore sue them by those fictitious names.

VI. Plaintiffs are informed and believe, and on the basis of that information and belief allege, that at all times mentioned in this complaint, defendants were the agents and employees of their codefendants, and in doing the things alleged in this complaint were acting within the course and scope of that agency and employment.

VII. Defendant is now, and at all times mentioned in this complaint was, a corporation organized and existing under the laws of the State of California, with its principal place of business in County, California.

VIII. Defendant is now, and at all times mentioned in this complaint was, in the business of designing, manufacturing, constructing, and assembling for use by members of the general public.

IX. Defendant is now, and at all times mentioned in this complaint was, a corporation organized and existing under the laws of the State of California, with its principal place of business in County, California.

X. Defendant is now, and at all times mentioned in this complaint was, in the business of selling for use by members of the general public.

XI. Sometime prior to decedent purchased from defendant a made by defendant for the sum of $ .

XII. At all times mentioned in this complaint, defendants and each of them so negligently and carelessly designed, manufactured, constructed, assembled, and sold the described above that it was dangerous and unsafe for its intended uses.

XIII. As a direct and proximate result of defendants' negligence and carelessness as described above, decedent was seriously injured on , while using the in the manner for which it was intended.

XIV. The injuries so inflicted on the decedent resulted in the decedent's death on .

XV. As the direct and proximate result of the foregoing and the death of the deceased, plaintiff has been deprived of a kind and loving spouse and of care, comfort, society, protection, love, companionship, affection, solace, moral support, loss of marital consortium, physical assistance in the operation and maintenance of the home, and financial support.

XVI. As a further direct and proximate result of the foregoing death of the deceased, plaintiff has been deprived of a kind and loving parent and of care, comfort, love, protection, advice, society, physical assistance, and financial support.

XVII. As a further direct and proximate result of the foregoing, plaintiffs have been generally damaged in a sum to be established according to proof, as provided by Code of Civil Procedure sections 425.10 and 425.11.

XVIII. As a further direct and proximate result of the death of the deceased, plaintiffs have incurred reasonable and necessary expenses for decedent's funeral, burial, and memorial services to their damage in a presently unascertained sum.

WHEREFORE, plaintiffs demand judgment as set forth below.

SECOND COUNT

(Strict Products Liability)

XIX. Plaintiffs incorporate by this reference each and all of the allegations contained in Paragraphs 1 through 18 of the First Count of this complaint as though fully set forth here.

XX. At all times mentioned in this complaint, the and its component parts were defective as to design, manufacture, and warnings, causing the and its component parts to be in a defective condition that made them dangerous and unsafe for their intended uses.

XXI. As a direct and proximate result of the dangerous and defective condition of the as described above, decedent was seriously injured on , while using the in the manner for which it was intended.

WHEREFORE plaintiffs demand judgment against defendants, and each of them, jointly and severally, as follows:

For general damages according to proof;

For special damages according to proof;

For costs of suit;

For pre judgment interest and post-judgment interest according to law; and

For such other and further relief as the court may deem just and proper.

VERIFICATION

I, , am a in the above-entitled action. I have read the foregoing and know the contents thereof. The same is true of my own knowledge, except as to those matters which are therein alleged on information and belief, and as to those matters, I believe it to be true.

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed at , California.