__[Attorney name]__
__[Address]__
__[Telephone number]__

Attorney for Plaintiff, __[name]__


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

_ _ _ _ _ _ _ _ _ _ _ _ _  )   No. _ _ _ _ _ _
                               Plaintiff(s))
vs.                                                        )CERTIFICATE OF IMPENDING
                                                                          )IMPAIRMENT 
_ _ _ _ _ _ _ _ _ _ _ _ _  )   (CCP 411.35(b)(2))
                               Defendant(s))
_________________________  )

__[Name]__ declares:
     1.   I am the attorney for plaintiff, __[name]__, in this
action.
     2.   This action is one for damages arising out of
professional negligence.
     3.   I am unable to obtain a consultation with a(n)
__[category of professional to be consulted]__ as required by
Code of Civil Procedure section 411.35 before the impairment of
this action.
     I certify under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.

Date: _ _ _ _ _ _                                          [Signature]
                                                                                                                                            _________________________
                                                                                                                                                                                    __[Typed name]__
                                                                                                                                            Attorney for _ _ _ _ _ _ _ _ _

      

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Legal Forms : Set Two