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

CONFIDENTIAL

FOR COURT USE ONLY

DAL-006

FAX NO.:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF 

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CONFIDENTIAL COVER SHEET AND DECLARATION RE DOCUMENTS 
FOR STAY AND EARLY EVALUATION CONFERENCE 

CASE NUMBER:

This Confidential Cover Sheet and Declaration should be affixed to the first page of any of the documents listed 
below.  It may not be used with other documents.

INSTRUCTIONS TO CLERK: Certain supporting documents to be filed along with or following an Application for Stay of 
Proceedings and Early Evaluation Conference are to be kept confidential, as provided by Civil Code sections 55.54(c)(6) and 
(d)(4)(A) and (5). Such document are not  to be made part of the public record except to the extent provided in Civil Code 
section 55.54(e)(4). 

 Attached hereto is a true and correct copy of one or more of the following documents (check all that apply): 

Report issued by a Certified Access Specialist on a site that is the subject of this litigation.  (This document may 
become publicly accessible at some point, under Civil Code section 55.54(e)(4).)

Wage report forms filed by defendant with the Employment  Development Department.

State or federal income tax returns filed by defendant.

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

1.

2.

3.

Date:

(TYPE OR PRINT NAME OF DECLARANT)

(SIGNATURE OF DECLARANT)

Form Adopted for Mandatory Use 
Judicial Council of California 
DAL-006 [Rev. July 1, 2013]

CONFIDENTIAL COVER SHEET AND DECLARATION RE DOCUMENTS 
FOR STAY AND EARLY EVALUATION CONFERENCE 
(Disability Access Litigation)

Page 1 of 1

Civil Code, § 55.54
www.courts.ca.gov