Madera — Language Access Complaint or Comment Form - Hmong (MAD-INT-003-H)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-int-003-h-language-access-complaint-or-comment-form-hmong-rev-04-15-2020.pdf

Superior Court of California, County of Madera Language Access Services 200 S G Street Madera, CA 93637 Email: Interpreter.Madera@madera.courts.ca.gov

DAIM FOOS HAIS KEV TSIS TXAUS SIAB LOS SIS HAIS TXOG KEV MUAB KEV PAB TXHAIS LUS

Lub tsev hais plaub Madera Superior Court yeej cog lus tias yuav muab kev pab txhais lus rau cov neeg uas tsis txawj to taub lus Askiv. Yog koj ntseeg tias tsis tau muab kev pab txhais lus rau koj uas zoo txaus los sis tsis yog los ntawm tus uas txawj txhais lus, thov sau daim foos no thiab xa rau peb tim ntsej tim muag, los sis xa ntawv, los sis xa email rau chaw nyob saud. Koj daim ntawv qhia kev tsis txaus siab no los yuav tsis muab txuas rau koj rooj hais plaub cov ntaub ntawv. Tsis txhob siv daim foos yog tias koj tsis txaus siab txog qhov kawg ntawm koj rooj hais plaub.

Thov khij ib qho: TSIS TXAUS SIAB MUAJ LUS HAIS

Xov Xwm txog tus uas Tsis Txaus Siab: (Koj tsis tas qhia koj cov xov xwm yog tias koj tsuas muaj lus xav hais xwb.)

HNUB NO: ________________________ LUB NPE LUB XEEM: _________________________________________________ CHAW NYOB: ______________________________________________ NROOG: ______________________ XEEV: ______________ ZIP CODE: ______________ XOV TOOJ: _____________________________ EMAIL: __________________________________ KEV TIV TAUJ KOJ ZOO TSHAJ: XA NTAWV XOV TOOJ EMAIL

THOV HAIS NTAU NPAUM LI KOJ HAIS TAUS TXOG QHOV UAS KOJ TSIS TXAUS SIAB/COV LUS XAV HAIS NYOB NRAM QAB NO:

Naj Npawb Rooj Hais Plaub: _____________________

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Xwv kom tshuaj xyuas qhov uas ua rau koj tsis txaus siab tas nrhog, tej zaum Tej Kev Muab Kev Pab Txhais Lus (Language Access Services, LAS) yuav tsum tiv tauj koj kom qhia xov xwm ntxiv. Thov nco qab tias yog koj txoj kev qhia tias koj tsis txaus siab tsis nyob hauv LAS qhov chaw txiav txim ces yuav xa mus rau chav hauj lwm tsim nyog kom tshuaj xyuas. Lub Tsev Hais Plaub yuav tiv tauj koj ua ntej dhau 60 hnub tom qab tau txais koj txoj kev qhia tias koj tsis txaus siab.

Sau Npe: _______________________________ Hnub Tim: _______________________

Madera Superior Court LANGUAGE ACCESS COMPLAINT OR COMMENT FORM Page 1 of 1 Form Adopted for Optional Use MAD-INT-003 H [Rev. 04/15/2020]