This form contains 93 fields organized into 31 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Case Number and Case Name
Case Number Text
Enter the court-assigned case number for this matter.
Case Name Text
Enter the case name (case title), typically the plaintiff and defendant names as shown on court filings.
Clerk Order Date and Clerk Name
Clerk Order Date Date
Enter the date the clerk signs or issues the order to go to court.
Clerk Name Text
Enter the name of the clerk who completes this order section.
Court Name and Street Address
Court Name and Street Address Text
Enter the full court name (including county) and the court’s street address where the case is filed.
Defendant - Doing Business Under Fictitious Name Checkbox
Defendant doing business under a fictitious name Checkbox
Check this box if either defendant listed above is doing business under a fictitious name (DBA), and attach form SC-103.
Defendant - More Than 2 Defendants Checkbox
Defendant - More than 2 defendants (attach form SC-120A) Checkbox
Check this box if there are more than two defendants in the case and you will attach form SC-120A.
Defendant (Additional) - Address
Additional Defendant Street Address Text
Enter the street address for the additional defendant (street number and street name).
Additional Defendant City Text
Enter the city for the additional defendant's address.
Additional Defendant State Text
Enter the state for the additional defendant's address.
Additional Defendant ZIP Code Text
Enter the ZIP code for the additional defendant's address.
Defendant (Additional) - Contact
Additional Defendant Name Text
Enter the full name of the next/additional defendant.
Additional Defendant Phone Text
Enter the phone number for the next/additional defendant.
Defendant (Additional) - Mailing Address (If Different)
Additional Defendant Mailing Address Street (If Different) Text
Enter the street address for the additional defendant’s mailing address, if it is different from the street address listed above. Fill only if 'Additional Defendant Street Address', 'Additional Defendant City', 'Additional Defendant State', 'Additional Defendant ZIP Code' is different (all).
Depends on: Additional Defendant Street Address, Additional Defendant City, Additional Defendant State, Additional Defendant ZIP Code
Additional Defendant Mailing Address City (If Different) Text
Enter the city for the additional defendant’s mailing address, if it is different from the address listed above. Fill only if 'Additional Defendant Street Address', 'Additional Defendant City', 'Additional Defendant State', 'Additional Defendant ZIP Code' is different (all).
Depends on: Additional Defendant Street Address, Additional Defendant City, Additional Defendant State, Additional Defendant ZIP Code
Additional Defendant Mailing Address State (If Different) Text
Enter the state for the additional defendant’s mailing address, if it is different from the address listed above. Fill only if 'Additional Defendant Street Address', 'Additional Defendant City', 'Additional Defendant State', 'Additional Defendant ZIP Code' is different (all).
Depends on: Additional Defendant Street Address, Additional Defendant City, Additional Defendant State, Additional Defendant ZIP Code
Additional Defendant Mailing Address ZIP Code (If Different) Text
Enter the ZIP code for the additional defendant’s mailing address, if it is different from the address listed above. Fill only if 'Additional Defendant Street Address', 'Additional Defendant City', 'Additional Defendant State', 'Additional Defendant ZIP Code' is different (all).
Depends on: Additional Defendant Street Address, Additional Defendant City, Additional Defendant State, Additional Defendant ZIP Code
Defendant (First) - Address
First Defendant Street Address Text
Enter the first defendant’s street address (street number and street name).
First Defendant City Text
Enter the city for the first defendant’s street address.
First Defendant State Text
Enter the state for the first defendant’s street address.
First Defendant ZIP Code Text
Enter the ZIP code for the first defendant’s street address.
Defendant (First) - Contact
First Defendant Name Text
Enter the full name of the first defendant (person, business, or public entity being sued).
First Defendant Phone Text
Enter the phone number for the first defendant.
Defendant (First) - Mailing Address (If Different)
First Defendant Mailing Address - Street Text
Enter the first defendant’s mailing street address, if different from the street address listed above. Fill only if 'First Defendant Street Address', 'First Defendant City', 'First Defendant State', 'First Defendant ZIP Code' is different (all).
Depends on: First Defendant Street Address, First Defendant City, First Defendant State, First Defendant ZIP Code
First Defendant Mailing Address - City Text
Enter the city for the first defendant’s mailing address, if different from the street address listed above. Fill only if 'First Defendant Street Address', 'First Defendant City', 'First Defendant State', 'First Defendant ZIP Code' is different (all).
Depends on: First Defendant Street Address, First Defendant City, First Defendant State, First Defendant ZIP Code
First Defendant Mailing Address - State Text
Enter the state for the first defendant’s mailing address, if different from the street address listed above. Fill only if 'First Defendant Street Address', 'First Defendant City', 'First Defendant State', 'First Defendant ZIP Code' is different (all).
Depends on: First Defendant Street Address, First Defendant City, First Defendant State, First Defendant ZIP Code
First Defendant Mailing Address - ZIP Code Text
Enter the ZIP code for the first defendant’s mailing address, if different from the street address listed above. Fill only if 'First Defendant Street Address', 'First Defendant City', 'First Defendant State', 'First Defendant ZIP Code' is different (all).
Depends on: First Defendant Street Address, First Defendant City, First Defendant State, First Defendant ZIP Code
Defendant's Claim - Amount Owed
Amount Defendant Claims Plaintiff Owes Number
Enter the total dollar amount the defendant claims the plaintiff owes.
Defendant's Claim - Calculation Details (c)
Calculation Details (c) Text
Explain how you calculated the amount the plaintiff owes you, excluding any court costs or service fees.
Defendant's Claim - Date Happened (b)
Date Happened (b) Date
Enter the date when the event occurred that forms the basis of the defendant’s claim.
Defendant's Claim - Explanation (a)
Defendant's Claim Explanation (a) Text
Provide a detailed explanation of why you claim the plaintiff owes you money.
Defendant's Claim - Need More Space Checkbox
Check here if you need more space Checkbox
Check this box if you need additional space to explain Item 3 (Defendant’s claim) and will attach an extra sheet or form MC-031.
Defendant's Claim - Time Period (b)
Time Period (b) - Date Started Date
Enter the start date of the time period during which the event happened, if no specific date is available. Fill only if 'Date Happened (b)' is not provided (no specific date).
Depends on: Date Happened (b)
Time Period (b) - Through Date Date
Enter the end date of the time period during which the event happened, if no specific date is available. Fill only if 'Date Happened (b)' is not provided (no specific date).
Depends on: Date Happened (b)
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
Defendant (list names) Text
Case Number Text
Yes CheckBox
No CheckBox
Yes CheckBox
No CheckBox
If yes, and if you have had arbitration, fill out form SC-101, attach it to this form, and check here CheckBox
Yes CheckBox
No CheckBox
A claim was filed on CheckBox
(date) Text
Yes CheckBox
No CheckBox
Date Text
Defendant types or prints name here Text
Date Text
Second defendant types or prints name here Text
Your county’s Small Claims Advisor can help for free Text
Header - Case Number
Header - Case Number Text
Enter the court-assigned case number for this matter.
Header - Defendant List Names
Defendant List Names Text
Enter the full name(s) of the defendant(s) in this case.
Hearing Schedule - First Date/Time/Department/Court Address
First Hearing Date Date
Enter the date of the first scheduled court hearing.
First Hearing Time Time
Enter the time of the first scheduled court hearing.
First Hearing Department Text
Enter the court department (department number or designation) for the first hearing.
First Hearing Court Name and Address Text
Enter the name and address of the court for the first hearing if it is different from the court information listed above. Fill only if 'Court Name and Street Address' is different (fill in this court name and address only if different from above).
Depends on: Court Name and Street Address
Hearing Schedule - Second Date/Time/Department/Court Address
Second Hearing Date Date
Enter the date of the second scheduled court hearing.
Second Hearing Time Time
Enter the time when the second scheduled court hearing begins.
Second Hearing Department Text
Enter the court department (department number or name) for the second hearing.
Second Hearing Court Name and Address Text
Enter the name and street address of the court for the second hearing if it is different from the court listed above. Fill only if 'Court Name and Street Address' is different (fill in this court name and address only if different from above).
Depends on: Court Name and Street Address
Hearing Schedule - Third Date/Time/Department/Court Address
Third Hearing Date Date
Enter the date of the third scheduled hearing.
Third Hearing Time Time
Enter the time of the third scheduled hearing.
Third Hearing Department Text
Enter the court department (department name or number) for the third hearing.
Third Hearing Court Name and Address Text
Enter the name and address of the court for the third hearing if it is different from the court listed above. Fill only if 'Court Name and Street Address' is different (fill in this court name and address only if different from above).
Depends on: Court Name and Street Address
Plaintiff - Active Military Checkbox and Name
Plaintiff on active military duty Checkbox
Check this box if any plaintiff is on active military duty, and then write that plaintiff’s name on the line provided.
Plaintiff Active Military Duty Name Text
Enter the name of the plaintiff who is on active military duty. Fill only if 'Plaintiff on active military duty' is 'Yes'.
Depends on: Plaintiff on active military duty
Plaintiff - More Than 2 Plaintiffs Checkbox
Plaintiff - Check here if more than 2 plaintiffs (attach form SC-120A) Checkbox
Check this box if there are more than two plaintiffs in the case and you will attach form SC-120A.
Plaintiff (Additional) - Address
Additional Plaintiff Street Address Text
Enter the street address for the additional (next listed) plaintiff.
Additional Plaintiff City Text
Enter the city for the additional (next listed) plaintiff’s address.
Additional Plaintiff State Text
Enter the state for the additional (next listed) plaintiff’s address.
Additional Plaintiff ZIP Code Text
Enter the ZIP code for the additional (next listed) plaintiff’s address.
Plaintiff (Additional) - Contact
Additional Plaintiff Name Text
Enter the full name of the next (additional) plaintiff.
Additional Plaintiff Phone Number Text
Enter the phone number for the next (additional) plaintiff.
Plaintiff (Additional) - Mailing Address (If Different)
Additional Plaintiff Mailing Street Address (If Different) Text
Enter the street address for the additional plaintiff's mailing address, if it is different from their street address. Fill only if 'Additional Plaintiff Street Address', 'Additional Plaintiff City', 'Additional Plaintiff State', 'Additional Plaintiff ZIP Code' is different (all).
Depends on: Additional Plaintiff Street Address, Additional Plaintiff City, Additional Plaintiff State, Additional Plaintiff ZIP Code
Additional Plaintiff Mailing City (If Different) Text
Enter the city for the additional plaintiff's mailing address, if it is different from their street address. Fill only if 'Additional Plaintiff Street Address', 'Additional Plaintiff City', 'Additional Plaintiff State', 'Additional Plaintiff ZIP Code' is different (all).
Depends on: Additional Plaintiff Street Address, Additional Plaintiff City, Additional Plaintiff State, Additional Plaintiff ZIP Code
Additional Plaintiff Mailing State (If Different) Text
Enter the state for the additional plaintiff's mailing address, if it is different from their street address. Fill only if 'Additional Plaintiff Street Address', 'Additional Plaintiff City', 'Additional Plaintiff State', 'Additional Plaintiff ZIP Code' is different (all).
Depends on: Additional Plaintiff Street Address, Additional Plaintiff City, Additional Plaintiff State, Additional Plaintiff ZIP Code
Additional Plaintiff Mailing ZIP Code (If Different) Text
Enter the ZIP code for the additional plaintiff's mailing address, if it is different from their street address. Fill only if 'Additional Plaintiff Street Address', 'Additional Plaintiff City', 'Additional Plaintiff State', 'Additional Plaintiff ZIP Code' is different (all).
Depends on: Additional Plaintiff Street Address, Additional Plaintiff City, Additional Plaintiff State, Additional Plaintiff ZIP Code
Plaintiff (First) - Address
First Plaintiff Street Address Text
Enter the first plaintiff's street address (street number and street name).
First Plaintiff City Text
Enter the city for the first plaintiff's address.
First Plaintiff State Text
Enter the state for the first plaintiff's address.
First Plaintiff ZIP Code Text
Enter the ZIP code for the first plaintiff's address.
Plaintiff (First) - Contact
First Plaintiff Name Text
Enter the full name of the first plaintiff (person, business, or public entity that sued first).
First Plaintiff Phone Number Text
Enter the phone number for the first plaintiff.
Plaintiff (First) - Mailing Address (If Different)
First Plaintiff Mailing Address Street Text
Enter the street address for the first plaintiff’s mailing address, if different from the street address listed above. Fill only if 'First Plaintiff Street Address', 'First Plaintiff City', 'First Plaintiff State', 'First Plaintiff ZIP Code' is different (all).
Depends on: First Plaintiff Street Address, First Plaintiff City, First Plaintiff State, First Plaintiff ZIP Code
First Plaintiff Mailing Address City Text
Enter the city for the first plaintiff’s mailing address, if different from the address listed above. Fill only if 'First Plaintiff Street Address', 'First Plaintiff City', 'First Plaintiff State', 'First Plaintiff ZIP Code' is different (all).
Depends on: First Plaintiff Street Address, First Plaintiff City, First Plaintiff State, First Plaintiff ZIP Code
First Plaintiff Mailing Address State Text
Enter the state for the first plaintiff’s mailing address, if different from the address listed above. Fill only if 'First Plaintiff Street Address', 'First Plaintiff City', 'First Plaintiff State', 'First Plaintiff ZIP Code' is different (all).
Depends on: First Plaintiff Street Address, First Plaintiff City, First Plaintiff State, First Plaintiff ZIP Code
First Plaintiff Mailing Address ZIP Code Text
Enter the ZIP code for the first plaintiff’s mailing address, if different from the address listed above. Fill only if 'First Plaintiff Street Address', 'First Plaintiff City', 'First Plaintiff State', 'First Plaintiff ZIP Code' is different (all).
Depends on: First Plaintiff Street Address, First Plaintiff City, First Plaintiff State, First Plaintiff ZIP Code