This form contains 334 fields organized into 72 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Amount Owed to Cross-Complainant
Cross-defendant named in item 5c above must pay cross-complainant on the cross-complaint CheckBox
Damages (1) Checkbox
Check this box if the amount owed to the cross-complainant includes damages.
Cross-Complainant Damages Number
Enter the amount of damages owed to the cross-complainant.
Prejudgment interest (2) Checkbox
Check this box if the amount owed to the cross-complainant includes prejudgment interest at the specified annual rate.
Cross-Complainant Prejudgment Interest Rate Number
Enter the annual rate of prejudgment interest owed to the cross-complainant.
Cross-Complainant Prejudgment Interest Amount Number
Enter the total monetary amount of prejudgment interest owed to the cross-complainant.
Attorney fees (3) Checkbox
Check this box if the amount owed to the cross-complainant includes attorney fees.
Cross-Complainant Attorney Fees Number
Enter the amount of attorney fees owed to the cross-complainant.
Costs (4) Checkbox
Check this box if the amount owed to the cross-complainant includes costs.
Cross-Complainant Costs Number
Enter the amount of costs owed to the cross-complainant.
Other (specify) (5) Checkbox
Check this box if the amount owed to the cross-complainant includes other specified amounts.
Cross-Complainant Other Specify Text
Specify any other items or categories for which an amount is owed to the cross-complainant.
Cross-Complainant Other Amount Number
Enter the monetary amount for other specified items owed to the cross-complainant.
Cross-Complainant Total Amount Number
Enter the total amount owed to the cross-complainant.
Amount Owed to Plaintiff
Defendant Pay Plaintiff on Complaint Checkbox
Check this box if the judgment requires the defendant named in item 5a to pay the plaintiff on the complaint.
Damages Checkbox
Check this box if the amount owed to the plaintiff includes damages.
Damages Amount Number
Enter the amount for damages owed to the plaintiff.
Prejudgment Interest Checkbox
Check this box if the amount owed to the plaintiff includes prejudgment interest.
Prejudgment Interest Rate Number
Enter the annual percentage rate for prejudgment interest owed to the plaintiff.
Prejudgment Interest Amount Number
Enter the total amount of prejudgment interest owed to the plaintiff.
Attorney Fees Checkbox
Check this box if the amount owed to the plaintiff includes attorney fees.
Attorney Fees Amount Number
Enter the amount for attorney fees owed to the plaintiff.
Costs Checkbox
Check this box if the amount owed to the plaintiff includes costs.
Costs Amount Number
Enter the amount for costs owed to the plaintiff.
Other (Specify) Checkbox
Check this box if the amount owed to the plaintiff includes other specified amounts.
Other (Specify) Text
Provide a description for any other amounts owed to the plaintiff not categorized above.
Other Amount Number
Enter the amount for other expenses specified as owed to the plaintiff.
Total Amount Owed Number
Enter the total amount owed to the plaintiff.
Appearing Defendant Names
First Appearing Defendant Checkbox
Check this box if the first defendant appeared and their name is to be listed below.
Appearing Defendant Name 1 Text
Enter the full name of the first defendant who appeared.
Appearing Defendant Name 2 Text
Enter the full name of the second defendant who appeared.
Additional Appearing Defendants on Attachment Checkbox
Check this box if additional defendants appeared and their names are listed on an attached document (Attachment 3b).
Appearing Defendant's Attorney Names
Defendant's Attorney 1 Checkbox
Check this box if the first defendant's attorney appeared.
Defendant's Attorney 1 Name Text
Enter the full name of the first appearing defendant's attorney.
Defendant's Attorney 2 Name Text
Enter the full name of the second appearing defendant's attorney.
Appearing Plaintiff Names
Plaintiff Appearance Checkbox
Check this box if a plaintiff appeared at the trial and their name(s) will be listed next to this checkbox.
Appearing Plaintiff Name 1 Text
Enter the full name of the first appearing plaintiff.
Appearing Plaintiff Name 2 Text
Enter the full name of the second appearing plaintiff.
Plaintiff Appearance Continued Checkbox
Check this box if the list of appearing plaintiff names continues on Attachment 3b.
Appearing Plaintiff's Attorney Names
Plaintiff's Attorney Checkbox
Check this box if a plaintiff's attorney appeared in the case.
Appearing Plaintiff's Attorney 1 Name Text
Enter the full name of the first appearing attorney for the plaintiff.
Appearing Plaintiff's Attorney 2 Name Text
Enter the full name of the second appearing attorney for the plaintiff.
Attorney Fees
attorney fees - amount Text
attorney fees - credits acknowledged Text
attorney fees - balance Text
Attorney or Party Information
State Bar Number Text
Enter the state bar number of the attorney.
Name Text
Provide the full name of the attorney or party without an attorney.
Firm Name Text
Enter the name of the law firm.
Street Address Text
Provide the street address.
City Text
Enter the city.
State Text
Provide the state.
Max length: 2 characters
Zip Code Text
Enter the zip code.
Telephone Number Text
Provide the telephone number.
Fax Number Text
Enter the fax number.
Email Address Text
Provide the email address.
Attorney For Name Text
Enter the name of the party the attorney represents.
State Text
Enter the state of the attorney or party.
Max length: 2 characters
Zip Code Text
Enter the ZIP code of the attorney or party.
City Text
Enter the city of the attorney or party.
Street Address Text
Enter the street address of the attorney or party.
Firm Name Text
Enter the name of the law firm.
Attorney or Party Name Text
Enter the full name of the attorney or the party without an attorney.
State Bar Number Text
Enter the State Bar number for the attorney, if applicable.
Telephone Number Text
Enter the telephone number of the attorney or party.
Fax Number Text
Enter the fax number of the attorney or party.
Email Address Text
Enter the email address of the attorney or party.
Attorney For (Name) Text
Enter the full name of the party for whom the attorney is appearing.
Attorney or Party Information Text
Provide the full name, State Bar number (if applicable), and complete address of the attorney or party who is not represented by an attorney.
Telephone Number Text
Enter the telephone number for the attorney or party.
Fax Number (Optional) Text
Provide the optional fax number for the attorney or party.
Email Address (Optional) Text
Enter the optional email address for the attorney or party.
Attorney Representing Text
Provide the name of the party that this attorney is representing.
By Default Judgment Details
Judgment By Default Checkbox
Check this box to indicate that the judgment is being entered by default against the defendant.
By Default - Clerk's Judgment Checkbox
Check this box if the default judgment is a Clerk's Judgment, meaning the defendant was sued only on a contract or judgment for the recovery of money.
By Default - Court Judgment Checkbox
Check this box if the default judgment is a Court Judgment, requiring the court to consider the case.
By Default Court Judgment - Plaintiff's Testimony and Evidence Checkbox
Check this box if, for a default Court Judgment, the court considered the plaintiff's testimony and other evidence.
By Default Court Judgment - Plaintiff's Written Declaration Checkbox
Check this box if, for a default Court Judgment, the court considered the plaintiff's written declaration.
Case and Party Information
Case Number Text
Enter the court's case number for this legal action.
Plaintiff/Petitioner Name Text
Enter the full name of the plaintiff or petitioner.
Defendant/Respondent Name Text
Enter the full name of the defendant or respondent.
Case Information
Plaintiff Text
Provide the full legal name of the plaintiff for this case.
Defendant Text
Provide the full legal name of the defendant for this case.
Case Number Text
Provide the official case number assigned to this legal proceeding.
Plaintiff/Petitioner Name Text
Enter the full name of the plaintiff or petitioner for this case.
Defendant/Respondent Name Text
Enter the full name of the defendant or respondent for this case.
Case Number Text
Enter the unique case number assigned to this legal matter.
Case Number Text
Enter the official case number assigned to this legal proceeding.
Plaintiff/Petitioner Name Text
Enter the full name of the plaintiff or petitioner in this case.
Defendant/Respondent Name Text
Enter the full name of the defendant or respondent in this case.
Reference or File Number Text
Enter any reference or file number associated with this case.
Plaintiff/Petitioner Name Text
Enter the full name of the plaintiff or petitioner in this case.
Defendant/Respondent Name Text
Enter the full name of the defendant or respondent in this case.
Case Number Text
Enter the unique identifying case number for this legal proceeding.
Case Number
Case Number Text
Enter the official case number assigned to this legal proceeding.
Case Number Text
Enter the case number for the court.
Case Parties
Plaintiff Name Text
Enter the full name of the plaintiff in this case.
Defendant Name Text
Enter the full name of the defendant in this case.
Plaintiff/Petitioner Text
Enter the name of the plaintiff or petitioner in this case.
Defendant/Respondent Text
Enter the name of the defendant or respondent in this case.
Clerk Details
Clerk Date Date
Enter the date for the clerk's details.
Clerk Checkbox
Check this box if the Clerk is signing or attesting to the document at this point.
Clerk's Certificate Date
Clerk's Certificate Date Date
Enter the date of the clerk's certificate.
Clerk's Judgment Options
Enter clerk’s judgment CheckBox
For Restitution of Premises Only Checkbox
Check this box if the requested clerk's judgment is solely for restitution of the premises and involves issuing a writ of execution, without applying Code of Civil Procedure section 1174(c).
Include All Occupants in Judgment Checkbox
Check this box to include all tenants, subtenants, named claimants, and other occupants of the premises in the judgment, asserting that the Prejudgment Claim of Right to Possession was served as required by Code of Civil Procedure section 415.46.
Under Code of Civil Procedure Section 585(a) Checkbox
Check this box if the clerk's judgment is being sought under Code of Civil Procedure section 585(a), requiring completion of the declaration under Code Civ. Proc., § 585.5 on the reverse side (item 5).
For Default Previously Entered Checkbox
Check this box if the clerk's judgment pertains to a default that was previously entered on a specific date.
Clerk's Judgment (3) Default Entry Date Date
Enter the date on which the default was previously entered.
Code of Civil Procedure Section
Code of Civil Procedure Section 416.10 (corporation) Checkbox
Check this box if the service was completed on behalf of a corporation under Code of Civil Procedure section 416.10.
Code of Civil Procedure Section 416.20 (defunct corporation) Checkbox
Check this box if the service was completed on behalf of a defunct corporation under Code of Civil Procedure section 416.20.
Code of Civil Procedure Section 416.30 (joint stock company/association) Checkbox
Check this box if the service was completed on behalf of a joint stock company or association under Code of Civil Procedure section 416.30.
Code of Civil Procedure Section 416.40 (association or partnership) Checkbox
Check this box if the service was completed on behalf of an association or partnership under Code of Civil Procedure section 416.40.
Code of Civil Procedure Section 416.50 (public entity) Checkbox
Check this box if the service was completed on behalf of a public entity under Code of Civil Procedure section 416.50.
Code of Civil Procedure Section 415.95 (business organization, form unknown) Checkbox
Check this box if the service was completed on behalf of a business organization of unknown form under Code of Civil Procedure section 415.95.
Code of Civil Procedure Section 416.60 (minor) Checkbox
Check this box if the service was completed on behalf of a minor under Code of Civil Procedure section 416.60.
Code of Civil Procedure Section 416.70 (ward or conservatee) Checkbox
Check this box if the service was completed on behalf of a ward or conservatee under Code of Civil Procedure section 416.70.
Code of Civil Procedure Section 416.90 (authorized person) Checkbox
Check this box if the service was completed on behalf of an authorized person under Code of Civil Procedure section 416.90.
Code of Civil Procedure Section 415.46 (occupant) Checkbox
Check this box if the service was completed on behalf of an occupant under Code of Civil Procedure section 415.46.
Code of Civil Procedure Section Other Checkbox
Check this box if the service was completed on behalf of a party under a Code of Civil Procedure section not listed above.
Other Code of Civil Procedure Section Number
Provide the Code of Civil Procedure section if it is not among the options listed above.
Complaint Filing Information
Complaint Filing Date Date
Enter the date the complaint or cross-complaint was filed.
Complaint Filed By Name Text
Enter the name of the party by whom the complaint or cross-complaint was filed.
Costs
Costs Amount Number
Enter the total amount of costs incurred.
Costs Credits Acknowledged Number
Enter the amount of costs acknowledged as credits.
Costs Balance Number
Enter the remaining balance for costs.
Court Information
Superior Court of California, County of Text
Branch Name Text
Provide the specific branch name of the court.
City and Zip Code Text
Enter the city and zip code for the court location.
Street Address Text
Enter the street address of the court.
Mailing Address Text
Provide the mailing address of the court.
Court County Text
Enter the name of the county for the Superior Court of California.
Court Street Address Text
Enter the street address of the court.
Court Mailing Address Text
Enter the mailing address of the court.
Court City and Zip Code Text
Enter the city and zip code of the court.
Court Branch Name Text
Enter the name of the court branch.
Court Judgment Request
Request Court Judgment Checkbox
Check this box if you are requesting a court judgment against the defendant under Code of Civil Procedure sections 585(b), 585(c), or 989.
Court Judgment Defendant Names Text
Enter the names of the defendants against whom a court judgment is requested.
Court Use Only
Default entered as requested Radiobutton
The court should check this box if the default was entered as requested by the applicant on the specified date.
Default NOT entered as requested Radiobutton
The court should check this box if the default was NOT entered as requested, and a reason for not entering it is provided.
Clerk's Name Text
Enter the name of the clerk.
Default Entered Date Date
Enter the date the default was entered as requested.
Reason Default Not Entered Text
Provide the reason why the default was not entered as requested.
Cross-Complainant Judgment Details
For Cross-Complainant Checkbox
Check this box if the judgment is entered for a cross-complainant.
Cross-Complainant Name Text
Enter the name of each cross-complainant for whom judgment is entered.
Cross-Defendant Name Text
Enter the name of each cross-defendant against whom judgment is entered.
Continued on Attachment 5c Checkbox
Check this box if the judgment details for the cross-complainant or cross-defendant are continued on Attachment 5c.
Cross-Defendant Judgment Details
Judgment for Cross-Defendant Checkbox
Check this box if the judgment is for the cross-defendant (name each).
Cross-Defendant Name Text
Enter the name of each cross-defendant for whom judgment is entered.
Cross-Defendant Recovery Details
Cross-complainant to receive nothing Checkbox
Check this box if the cross-complainant is to receive no recovery from the cross-defendant named in item 5d.
Cross-defendant to recover costs Checkbox
Check this box if the cross-defendant named in item 5d is to recover costs.
Cross-Defendant Recovered Costs Number
Enter the amount of costs the cross-defendant named in item 5d is to recover.
Cross-defendant to recover attorney fees Checkbox
Check this box if the cross-defendant named in item 5d is also to recover attorney fees.
Cross-Defendant Recovered Attorney Fees Number
Enter the amount of attorney fees the cross-defendant named in item 5d is to recover.
Daily Damages Information
Daily Damage Rate Number
Enter the daily rate for damages that were demanded in the complaint.
Daily Damages Start Date Date
Enter the date from which daily damages began.
Declarant Information
Declarant Date Date
Enter the date the declaration is made.
Declarant Printed Name Text
Enter the full name of the declarant.
Declaration
Declare under penalty of perjury Checkbox
Check this box if you declare under penalty of perjury that the foregoing information is true and correct.
California sheriff or marshal certification Checkbox
Check this box if you are a California sheriff or marshal and certify that the foregoing information is true and correct.
Declaration of Action Type
Declaration 585.5 Checkbox
Check this box to declare that this action falls under Code Civ. Proc., § 585.5 for entry of default.
Action 5a: Is Contract or Installment Sale Checkbox
Check this box if this action is on a contract or installment sale for goods or services subject to Civ. Code, § 1801 et seq. (Unruh Act).
Action 5a: Is Not Contract or Installment Sale Checkbox
Check this box if this action is not on a contract or installment sale for goods or services subject to Civ. Code, § 1801 et seq. (Unruh Act).
Action 5b: Is Not Conditional Sales Contract Checkbox
Check this box if this action is not on a conditional sales contract subject to Civ. Code, § 2981 et seq. (Rees-Levering Motor Vehicle Sales and Finance Act).
Action 5b: Is Conditional Sales Contract Checkbox
Check this box if this action is on a conditional sales contract subject to Civ. Code, § 2981 et seq. (Rees-Levering Motor Vehicle Sales and Finance Act).
Action 5c: Is Not Obligation for Goods, Services, Loans, or Credit Checkbox
Check this box if this action is not on an obligation for goods, services, loans, or extensions of credit subject to Code Civ. Proc., § 395(b).
Action 5c: Is Obligation for Goods, Services, Loans, or Credit Checkbox
Check this box if this action is on an obligation for goods, services, loans, or extensions of credit subject to Code Civ. Proc., § 395(b).
Declaration of Mailing
6a Not mailed Radiobutton
Check this box if the Request for Entry of Default was not mailed to defendants whose addresses are unknown to the plaintiff or plaintiff's attorney.
6b Mailed first-class Radiobutton
Check this box if the Request for Entry of Default was mailed first-class, postage prepaid, to each defendant's attorney of record or last known address.
Unknown Address Defendants Text
Enter the names of the defendants to whom the document was not mailed because their addresses are unknown to the plaintiff or plaintiff's attorney.
Mailing Date Date
Enter the date the document was mailed.
Envelope Names and Addresses Text
Enter the names and addresses that were shown on the envelopes when the document was mailed.
Defendant Default Information
Enter default of defendant Checkbox
Check this box to request that the clerk enter the default of the named defendant(s).
Default Defendant Names Text
Please provide the full name(s) of the defendant(s) for whom default is being entered.
Defendant Judgment Details
5b. Judgment For Defendant Checkbox
Check this box if the judgment is entered for the defendant(s) named.
Defendant Judgment Name Text
Enter the name of each defendant against whom judgment is entered.
Defendant Non-Appearance
Defendant Did Not Appear At Trial Checkbox
Check this box if, after the court trial, the defendant did not appear, and was properly served with notice of trial.
Defendant Recovery Details
Plaintiff to receive nothing from Defendant 5b Checkbox
Check this box if the plaintiff is to receive no money from the defendant named in item 5b.
Defendant 5b recovers costs Checkbox
Check this box if the defendant named in item 5b is to recover costs.
Defendant Recovered Costs Number
Enter the amount of costs the defendant named in item 5b is to recover.
Defendant 5b recovers attorney fees Checkbox
Check this box if the defendant named in item 5b is to recover attorney fees.
Defendant Recovered Attorney Fees Number
Enter the amount of attorney fees the defendant is to recover.
Demand of Complaint Judgment
Demand of Complaint Amount Number
Enter the total amount demanded in the complaint.
Demand of Complaint Credits Acknowledged Number
Enter the total amount of credits acknowledged for the demand of complaint.
Demand of Complaint Balance Number
Enter the remaining balance for the demand of complaint after deducting credits.
Documents Served
Summons Checkbox
Check this box if a summons was among the documents served.
Complaint Checkbox
Check this box if a complaint was among the documents served.
Alternative Dispute Resolution (ADR) Package Checkbox
Check this box if an Alternative Dispute Resolution (ADR) package was among the documents served.
Civil Case Cover Sheet Checkbox
Check this box if a Civil Case Cover Sheet was served, which is typically for complex cases.
Cross-Complaint Checkbox
Check this box if a cross-complaint was among the documents served.
Other Documents Checkbox
Check this box if other documents not explicitly listed were served and specify them in the adjacent field.
Other Documents Served Text
Enter a description of other documents that were served.
First Declaration
First Declaration Date Date
Enter the date this declaration was made.
First Declaration Declarant's Name Text
Enter the full typed or printed name of the individual making this declaration.
General
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General Damages
General Damages Amount Number
Enter the amount for general damages.
General Damages Credits Acknowledged Number
Enter the credits acknowledged for general damages.
General Damages Balance Number
Enter the balance for general damages.
Interest
Interest Amount Number
Enter the total amount of interest.
Interest Credits Acknowledged Number
Enter the amount of interest credits acknowledged.
Interest Balance Number
Enter the remaining balance of the interest.
Judgment Debtor Details
Judgment Debtor is Natural Person Checkbox
Check this box if the judgment debtor is a natural person, as provided in the relevant statute.
Judgment Debtor Medical Expenses Amount Number
Enter the amount of the judgment that is on a claim related to medical expenses.
Judgment Debtor Personal Debt Amount Number
Enter the amount of the judgment that is on a claim related to personal debt.
Judgment Debtor Consumer Debt Included Amount Number
Enter the amount of the personal debt judgment that includes consumer debt.
Judgment Entry Authority
The Court Checkbox
Check this box if the judgment is entered by the court.
The Clerk Checkbox
Check this box if the judgment is entered by the clerk.
Judgment Type
By Clerk Checkbox
Check this box if the judgment is entered by the clerk.
By Court Checkbox
Check this box if the judgment is entered by the court.
By Default Checkbox
Check this box if the judgment is entered by default.
On Stipulation Checkbox
Check this box if the judgment is entered based on a stipulation.
After Court Trial Checkbox
Check this box if the judgment is entered after a court trial.
Defendant Did Not Appear at Trial Checkbox
Check this box if the judgment is entered because the defendant did not appear at trial.
Judicial Officer Details
Judicial Officer Date Date
Enter the date of the judicial officer's action or signature.
Clerk, by Checkbox
Check this box if the judgment is being entered by the Clerk.
Legal Assistant Declaration
Legal document assistant or unlawful detainer assistant information is on the reverse Checkbox
Check this box if legal document assistant or unlawful detainer assistant information is on the reverse side of the form, especially if the form is filed in an unlawful detainer case.
Legal Document Assistant Information
Did Give Assistance Radiobutton
Check this box if a legal document assistant or unlawful detainer assistant did, for compensation, give advice or assistance with this form.
Did Not Give Assistance Radiobutton
Check this box if a legal document assistant or unlawful detainer assistant did not, for compensation, give advice or assistance with this form.
Assistant's Name Text
Enter the name of the legal document assistant or unlawful detainer assistant.
Assistant's Street Address, City, and Zip Code Text
Enter the complete street address, city, and zip code of the legal document assistant or unlawful detainer assistant.
Assistant's Telephone Number Text
Enter the telephone number of the legal document assistant or unlawful detainer assistant.
Assistant's County of Registration Text
Enter the county where the legal document assistant or unlawful detainer assistant is registered.
Assistant's Registration Number Text
Enter the registration number of the legal document assistant or unlawful detainer assistant.
Assistant's Registration Expiration Date Date
Enter the date when the legal document assistant's or unlawful detainer assistant's registration expires.
Memorandum of Costs
Clerk's Filing Fees Number
Enter the amount for the clerk's filing fees.
Process Server's Fees Number
Enter the amount for the process server's fees.
Other Costs Specify Type Text
Specify the type of other costs being claimed.
Other Costs Amount Number
Enter the amount for the specified other costs.
Additional Cost Item Specify Type Text
Specify the type of this additional cost item.
Additional Cost Item Amount Number
Enter the amount for this additional cost item.
Total Memorandum of Costs Number
Enter the total amount of all claimed costs in this memorandum.
Costs and disbursements are waived Checkbox
Check this box if the costs and disbursements are being waived.
On Stipulation Judgment Details
2. On Stipulation Checkbox
Check this box if the judgment is being entered based on an agreement (stipulation) between the plaintiff and defendant, and the court approved the stipulated judgment.
2b. Signed Written Stipulation Filed Checkbox
Check this box if a signed written stipulation related to the judgment was filed in the case.
2c. Stipulation Stated In Open Court Checkbox
Check this box if the stipulation for the judgment was stated verbally in open court.
2c. Stipulation Stated On The Record Checkbox
Check this box if the stipulation for the judgment was stated and recorded on the official court record.
Other Means of Service
Other Means of Service Checkbox
Check this box if service was performed by means other than mail with acknowledgment of receipt, and then specify the means of service and authorizing code section.
Other Means of Service Details Text
Provide a detailed description of the other means of service used and the authorizing code section.
Other Specification
8. Other (specify) Checkbox
Check this box if there are other specifications to be provided for item 8.
Other Specification Text
Enter the specific details for the 'Other' category.
Party and Person Served
3a. Party Served Name Text
Enter the name of the party served as it is shown on the documents served.
3b. Person Served as Agent Checkbox
Check this box if the person served is an individual acting as an authorized agent for an entity, who is not the party named in item 3a and not a person for whom substituted service was made under item 5b.
3b. Person Served Name and Relationship Text
Enter the name of the person served on behalf of an entity or as an authorized agent, and their relationship to the party named in item 3a.
Person Served Details
Served as Individual Defendant Checkbox
Check this box if the notice was completed for an individual defendant.
Served as Fictitious Name Defendant Checkbox
Check this box if the notice was completed for a person sued under a fictitious name.
Fictitious Name of Person Served Text
Enter the fictitious name under which the person was sued.
Served as Occupant Checkbox
Check this box if the notice was completed for an occupant.
Served On Behalf Of Checkbox
Check this box if the notice was completed on behalf of another entity or person, as specified.
Notice On Behalf Of Text
Specify on whose behalf the 'Notice to the Person Served' was completed.
Personal Service Details
by personal service Checkbox
Check this box if you personally delivered the documents listed in item 2 to the party or person authorized to receive service of process.
Personal Service Date Date
Enter the date when the documents were personally delivered to the party or authorized person.
Personal Service Time Time
Enter the time when the documents were personally delivered to the party or authorized person.
Plaintiff Judgment Details
For Plaintiff Checkbox
Check this box if the judgment is for the plaintiff(s).
Plaintiff Name Text
Enter the full name of each plaintiff for whom the judgment is entered.
Defendant Name Text
Enter the full name of each defendant against whom the judgment is entered.
Continued on Attachment 5a Checkbox
Check this box if the details for the judgment for the plaintiff are continued on Attachment 5a.
Reasons for Nonmilitary Status Declaration
Search Results from DMDC Checkbox
Check this box if official search results from the DMDC website confirm the defendant/respondent is not in U.S. military service.
Regular Communication Checkbox
Check this box if you are in regular communication with the defendant/respondent and are aware they are not in U.S. military service.
Defendant/Respondent Stated Nonmilitary Checkbox
Check this box if you recently contacted the defendant/respondent and they verbally confirmed they are not in U.S. military service.
Defendant/Respondent Discharged Checkbox
Check this box if you know the defendant/respondent was discharged from U.S. military service.
Discharge Date Date
Enter the date the defendant/respondent was discharged from U.S. military service.
Not Eligible for Military Service Checkbox
Check this box if the defendant/respondent is not eligible to serve in the U.S. military for a specific reason, detailed below.
Incarcerated Checkbox
Check this box if the defendant/respondent is not eligible to serve in the U.S. military because they are incarcerated.
Business Entity Checkbox
Check this box if the defendant/respondent is not eligible to serve in the U.S. military because they are a business entity.
Other Reason for Nonmilitary Status Checkbox
Check this box if there is another unlisted reason for the defendant/respondent's nonmilitary status and specify it.
Other Nonmilitary Status Reason Text
Provide other reasons not listed for why the defendant/respondent is not in the U.S. military service.
Request for Application
Entry of Default Checkbox
Check this box if you are requesting an entry of default.
Clerk's Judgment Checkbox
Check this box if you are requesting a clerk's judgment.
Court Judgment Checkbox
Check this box if you are requesting a court judgment.
Second Declaration
Second Declaration Date Date
Enter the date of the second declaration.
Second Declaration Printed Name Text
Enter the typed or printed name of the declarant for the second declaration.
Server Information
Server Name Text
Enter the full name of the person who served the papers.
Server Address Text
Enter the full mailing address of the person who served the papers.
Server Telephone Number Text
Enter the telephone number of the person who served the papers.
Server Status
1) Not a Registered California Process Server Checkbox
Check this box if the person who served papers is not a registered California process server.
2) Exempt from Registration Checkbox
Check this box if the person who served papers is exempt from registration under Business and Professions Code section 22350(b).
3) A Registered California Process Server Checkbox
Check this box if the person who served papers is a registered California process server.
Registered Process Server - Owner Checkbox
Check this box if the registered California process server is an owner.
Registered Process Server - Employee Checkbox
Check this box if the registered California process server is an employee.
Registered Process Server - Independent Contractor Checkbox
Check this box if the registered California process server is an independent contractor.
Server Registration Number Text
Enter the registration number of the California process server.
Server Registration County Text
Enter the county where the California process server is registered.
Service Addendum
Additional Service Page Attached Checkbox
Check this box if an additional page describing the service provided is attached to this document.
Service Address
Service Address Text
Enter the complete address where the party was served.
Service by Mail Details
Service by Mail and Acknowledgment Checkbox
Check this box if you mailed the documents listed in item 2 to the party at the address shown in item 4 by first-class mail, postage prepaid, with acknowledgment of receipt of service.
Service by Mail Date Date
Provide the date when the documents were mailed.
Service by Mail City Text
Provide the city from which the documents were mailed.
(3) With Notice and Acknowledgment Copies Checkbox
Check this box if the mailing included two copies of the Notice and Acknowledgment of Receipt and a postage-paid return envelope addressed to you.
(4) To an Address Outside California with Return Receipt Checkbox
Check this box if the documents were mailed to an address outside California and a return receipt was requested.
Service Fee
Service Fee Amount Number
Enter the total fee charged for the service.
Signature Block
Signature Date Date
Enter the date the form was signed.
Signer Name Text
Enter the full name of the person who served the papers, sheriff, or marshal.
Signature of Plaintiff or Attorney
type or print name Text
Signature Date Date
Enter the date the plaintiff or attorney signed the document.
Special Damages
Special Damages Amount Number
Enter the amount for special damages.
Special Damages Credits Acknowledged Number
Enter the credits acknowledged for special damages.
Special Damages Balance Number
Enter the balance for special damages.
Statement of Decision
Statement of Decision Checkbox
Check this box if a statement of decision was given.
Statement of Decision Was Not Given Checkbox
Check this box if a statement of decision was not given.
Statement of Decision Was Requested Checkbox
Check this box if a statement of decision was requested.
Stipulated Judgment
Stipulated Judgment Checkbox
Check this box if the judgment is entered according to the stipulation of the parties.
Substituted Service Details
Substituted Service Checkbox
Check this box if the service was performed by substituted service.
Substituted Service Date Date
Enter the date when the substituted service was made.
Substituted Service Time Time
Enter the time when the substituted service was made.
Substituted Service Recipient Name and Relationship Text
Provide the name and title or relationship of the person who received the documents during substituted service, as indicated in item 3.
Substituted Service (1) Business Checkbox
Check this box if the documents were left with a person at least 18 years of age in charge at the business office or usual place of business of the person to be served.
Substituted Service (2) Home Checkbox
Check this box if the documents were left with a competent household member at least 18 years of age at the dwelling house or usual place of abode of the party.
Substituted Service (3) Physical Address Unknown Checkbox
Check this box if the documents were left with a person at least 18 years of age in charge at the usual mailing address (excluding a P.O. Box) when the physical address of the person to be served was unknown.
Substituted Service (4) Mailed Copies Checkbox
Check this box if, after leaving the copies, you thereafter mailed copies of the documents by first-class, postage prepaid to the person served at the place where the copies were left, as per Code Civ. Proc., § 415.20.
Mailing Date Date
Enter the date when the documents were mailed by first-class, postage prepaid after substituted service.
Mailing City Text
Enter the city from which the documents were mailed after substituted service.
Declaration of Mailing Attached Checkbox
Check this box if a declaration of mailing is attached for the documents that were mailed.
Substituted Service (5) Declaration of Diligence Checkbox
Check this box if you attach a declaration of diligence stating the actions taken to first attempt personal service before resorting to substituted service.
Superior Court Information
Superior Court County Text
Enter the name of the county where the Superior Court of California is located.
Superior Court Street Address Text
Enter the street address for the Superior Court.
Superior Court Mailing Address Text
Enter the mailing address for the Superior Court.
Superior Court City and Zip Code Text
Enter the city and zip code for the Superior Court.
Superior Court Branch Name Text
Enter the branch name of the Superior Court.
Total Judgment
TOTALS - credits acknowledged Text
Total Judgment Credits Acknowledged Number
Enter the total amount of credits acknowledged against the judgment.
Total Judgment Balance Number
Enter the total balance of the judgment.
Trial Details
After Court Trial Checkbox
Check this box if the judgment was entered after a court trial where the jury was waived and the court considered the evidence.
Trial Date and Time Date
Enter the date and time when the case was tried.
Judicial Officer Name Text
Enter the name of the judicial officer before whom the case was tried.