[your name]
[your mailing address]
[your city, state fully spelled]
[optional phone number]
[optional e-mail]
In Propria Persona

                                           
SUPERIOR COURT OF CALIFORNIA

COUNTY OF LOS ANGELES, 

[your name],                        ) CASE NO. [to be assigned]
                                    ) 
       Demandant,                   ) NOTICE AND DEMAND
                                    ) 
            v.                      ) 
                                    ) 
[his name],                         ) 
                                    ) 
       Respondent.                  ) 
                                    ) 
------------------------------------)---------------------------

NOTE:
THE FOLLOWING TEXT SHOULD BE 12 POINT TYPE,
BUT IS ENLARGED HERE FOR DISPLAY BY THE PROJECTOR

TO [his name] AND ALL PARTIES ACTING IN CONCERT WITH YOU, PLEASE TAKE NOTICE OF THE FOLLOWING:

1.  You stepped on my toe.
  
2.  Now my toe is broken.  I paid $3,000 for medical treatment.

3.  You have a duty to not injure me.

4.  You breached that duty.

5.  The damages are $3,000.

6.  I demand that you, in good faith, pay me the damages within thirty (30) days from the date you are served with this Notice and Demand.

7.  If you do not pay or otherwise respond within the allotted time, then by tacit procuration (implied power of attorney) I will determine for you the facts, your duties, and the damages you owe to me.

8.  If you do not respond as demanded, I will take lawful action (in personam and in rem) to defend against you, and persons acting in concert with you, who caused said injuries, to secure my substantive rights, and to redeem the damages owed to me.

9.  I have personal knowledge of the foregoing facts and am competent to testify as to the truth of those facts if called as a witness.  I declare under penalty of perjury that the foregoing facts are true and correct, and that this affidavit was executed in _[city]______, __[state]__ on _____[date]______.

          _________[your signature]________
          			[type your name]