Form SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court Completed Form Examples and Samples
Find clear, filled-out examples and samples of California's Form SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court. Our detailed samples, covering common scenarios like landlord-tenant disputes, guide you on how to properly complete the form for your small claims case.
Form SC-100 Example: Landlord Claim for Unpaid Rent & Damages
How this form was filled:
This is an example of a completed Form SC-100 where a landlord, Maria Garcia, is suing a former tenant, David Chen, for $3,500 in small claims court. The claim covers one month of unpaid rent and the cost to repair damages to the rental property that exceeded the security deposit.
Information used to fill out the document:
- Plaintiff Name: Maria Garcia
- Plaintiff Address: 456 Oak St, San Francisco, CA 94117
- Defendant Name: David Chen
- Defendant Address: 789 Pine St, Apt 2B, San Francisco, CA 94108
- Court Name: Superior Court of California, County of San Francisco
- Court Address: 400 McAllister St, San Francisco, CA 94102
- Total Claim Amount: $3,500.00
- Date Claim Arose: February 1, 2026
- Location of Dispute: 123 Maple Ave, San Francisco, CA 94110
- Reason for Claim: Defendant moved out on 02/01/2026, failed to pay the last month's rent of $1,500, and left damages (stained carpets, holes in walls) costing $2,000 to repair.
- Claim Explanation: 1. Unpaid Rent for January 2026: $1,500. 2. Cost to replace damaged carpet: $1,200. 3. Cost to repair and repaint walls: $800.
- Filing Date: March 15, 2026
What this filled form sample shows:
- Clearly identifies the plaintiff (landlord) and defendant (tenant) with their current addresses.
- Provides a specific claim amount and a brief breakdown of how it was calculated (unpaid rent + damages).
- States a concise and factual reason for the lawsuit, as required by the form.
- Includes the correct court information for the county where the defendant lives or the dispute occurred.
Form specifications and details:
| Use Case: | Landlord suing a former tenant for unpaid rent and property damages. |
| Form: | SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court |
| Jurisdiction: | California, USA |
Created: February 13, 2026 01:55 AM
