This form contains 56 fields organized into 11 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Defendants Checkbox
Additional Defendants Checkbox
Check this box if your case is against more than two defendants and you need to fill out and attach another form SC-100A.
First Declaration
Declaration Date Date
Provide the date of the declaration.
Max length: 20 characters
Declarant Name Text
Provide the full name of the person making the declaration.
Fourth Plaintiff Information
Fictitious Name - Yes Checkbox
Check this box if the fourth plaintiff is doing business under a fictitious name.
Fictitious Name - No Checkbox
Check this box if the fourth plaintiff is not doing business under a fictitious name.
Fourth Plaintiff Street Address Text
Enter the street number and name for the fourth plaintiff's primary address.
Fourth Plaintiff City Text
Enter the city for the fourth plaintiff's primary address.
Fourth Plaintiff State Text
Enter the state for the fourth plaintiff's primary address.
Fourth Plaintiff Zip Code Text
Enter the zip code for the fourth plaintiff's primary address.
Fourth Plaintiff Mailing Street Address (if different) Text
If different from the primary street address, enter the street number and name for the fourth plaintiff's mailing address.
Fourth Plaintiff Mailing Zip Code (if different) Text
If different from the primary zip code, enter the zip code for the fourth plaintiff's mailing address.
Fourth Plaintiff Mailing State (if different) Text
If different from the primary state, enter the state for the fourth plaintiff's mailing address.
Fourth Plaintiff Mailing City (if different) Text
If different from the primary city, enter the city for the fourth plaintiff's mailing address.
Fourth Plaintiff Name Text
Enter the full name of the fourth plaintiff.
Fourth Plaintiff Phone Number Text
Enter the phone number for the fourth plaintiff.
General
Print this form Button
Save this form Button
Clear this form Button
For your protection and privacy, please press the Clear This Form button after you have printed the form Button
If more than two plaintiffs (person, business, or entity suing), list their information below: (1)
Case Number Text
Provide the court case number for this legal proceeding.
This form is attached to form SC-100, item 1 or 2. Checkbox
Check this box if this SC-100A form is being used as an attachment to form SC-100, specifically for information related to item 1 or 2 on form SC-100.
Is your claim for more than $2,500?
No Checkbox
Check this box if your claim is not for more than $2,500.
Yes Checkbox
Check this box if your claim is for more than $2,500.
More than 4 Plaintiffs Checkbox
More than 4 Plaintiffs Checkbox
Check this box if there are more than 4 plaintiffs, and you need to fill out and attach another form SC-100A.
Other Defendant Information
Other Defendant's Name Text
Enter the full name of the additional defendant.
Defendant's Street Address Text
Enter the street address of the defendant.
Defendant's Zip Code (Street Address) Text
Enter the zip code of the defendant's street address.
Defendant's State (Street Address) Text
Enter the state of the defendant's street address.
Defendant's City (Street Address) Text
Enter the city of the defendant's street address.
Defendant's Mailing Street Address (if different) Text
Enter the mailing street address of the defendant if it is different from the primary street address.
Defendant's Mailing Zip Code (if different) Text
Enter the zip code of the defendant's mailing address if it is different.
Defendant's Mailing State (if different) Text
Enter the state of the defendant's mailing address if it is different.
Defendant's Mailing City (if different) Text
Enter the city of the defendant's mailing address if it is different.
Agent Name for Service of Process Text
Enter the name of the person or agent authorized for service of process for the defendant. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Agent's Street Address for Service of Process Text
Enter the street address of the person or agent authorized for service of process. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Agent's Zip Code for Service of Process Text
Enter the zip code of the agent's address for service of process. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Agent's State for Service of Process Text
Enter the state of the agent's address for service of process. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Agent's City for Service of Process Text
Enter the city of the agent's address for service of process. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Defendant's Phone Text
Enter the phone number of the defendant.
Agent Job Title (if known) Text
Enter the job title of the person or agent authorized for service of process, if known. Fill only if 'Other Defendant's Name' is a corporation, limited liability company, or public entity.
Depends on: Other Defendant's Name
Page Number
Current page number Text
Enter the current page number of this form (the page index within the document).
Total number of pages Text
Enter the total number of pages in this document so the page count reads 'page X of Y'.
Second Declaration
Second Declarant Date Date
Please provide the date of the declaration.
Max length: 20 characters
Second Declarant Name Text
Please type or print the full name of the second declarant.
Third Plaintiff Information
Plaintiff Mailing Street Address Text
If different from the physical address, enter the street number and name for the third plaintiff's mailing address.
Plaintiff Mailing Zip Code Text
If different from the physical address, enter the zip code for the third plaintiff's mailing address.
Plaintiff State Text
Enter the state for the third plaintiff's physical address.
Plaintiff Zip Code Text
Enter the zip code for the third plaintiff's physical address.
Plaintiff Name Text
Enter the full legal name of the third plaintiff, which can be a person, business, or other entity.
Plaintiff Street Address Text
Enter the street number and name for the third plaintiff's physical address.
Plaintiff City Text
Enter the city for the third plaintiff's physical address.
Fictitious Name: Yes Checkbox
Check this box if the third plaintiff is doing business under a fictitious name.
Fictitious Name: No Checkbox
Check this box if the third plaintiff is NOT doing business under a fictitious name.
Plaintiff Mailing State Text
If different from the physical address, enter the state for the third plaintiff's mailing address.
Plaintiff Mailing City Text
If different from the physical address, enter the city for the third plaintiff's mailing address.
Plaintiff Phone Number Text
Enter the phone number for the third plaintiff.