• You and the Plaintiff must go to the court on the trial date listed below.

If
you do not go to court, you may lose the case.
Notice to the person being sued:
• You are the Defendant if your name is listed in (2) on page 2 of this
form. The person suing you is the Plaintiff.
50'·100
Plaintiff's Claim and ORDER
to Go to Small Claims Court
Clerk stamps date here when form is filed.
~ O ~ ~ r Q j
SUPERIOR COURT OF CALIFORNIA
COUNTY OF RIVERSIDE
APR 03 2006
\\\&
• If you Jose, the court can order that your wages, money, or property be
taken to pay this claim.
• Bring witnesses, receipts, and any evidence you need to prove your case.
• Read pages 2 and 3 of this form to understand the Plaintiffs claim against
you and page 4 of this form to protect your rights.
Aviso al demandando:
• Usted es el Demandado si su nombre figura in (2) de la pagina 2
de este formulario. La persona que 10 demanda es el Demandante.
• Usted yel Demandante tienen que presentarse en la corte en la
fecha del juicio indicada a continuacion. Si no se presenta, puede
perder el caso.
Fill out court name andstreet address:
Superior Court of california, County of Riverside
880 North State Street
Hemet, CA 92543
Clerk fills in case number when form is filed.
I<aRN"mOer.
HES011671
• Si pierde el caso la corte podria ordenar que Ie quiten de su
sueldo, dinero u otros bienes para pagar este reclamo.
• L1eve testigos, recibos y cualquier otra prueba que necesite para probar su caso.
• Lea las paginas 2 y 3 de este formulario para entender la demanda en su contra y la pagina 5 de este formulario
para proteger sus derechos.
Order to Go to Court
The people in (1) and (2) must go to court on: (Clerk fills out below)
Trial
Date Time Department Name and address of court if different from above
Date 1.
06/08/06
1:30 PM H5
2.
3.
Date: 04/03/06 Clerk by, MINERVA TRILLO
Instructions for the person suing:
• You are the Plaintiff. The person you are suing is the Defendant.
• Before you fill out this form, read Form 5C-150, Information for the Small Claims Plaintiff, to know your rights. Get
5C-150 at any courthouse, county law library, or go to www.courtinfo.ca.gov/forms
• Fill out pages 2 and 3 of this form. Then take or mail it to the courthouse clerk's office and pay your fee. The clerk
will write your trial date in the box above.
• You must have someone 18 or over--not you or anyone else involved with this case--give each Defendant a copy of
all 5 pages of this form and any pages this form tells you to attach. Keep a copy for your records.
• Go to court on your trial date listed above. Bring witnesses, receipts, and any evidence you needed to prove your case.
Judicial Council of California, www.courtinfo.ca.gov
Rev. January 1, 2005, Mandatory Form
Code of Civil Procedure, §§ 116.110 et seq.,
116.220(c),116.340(g)
FORM: CSCPC
Plaintiffs Claim and ORDER
to Go to Small Claims Court
(Small Claims)
SC-100, Page 1 of 5
,----------------------------,---------- _.j
Plaintiff (list names):
CD The Plaintiff (the person, business, or pUblic entity that is suing) is:
Name: m'*t-..J £A.JC.
Street address: S33 Ec.est J'14t.W $+Ced"J 'Sao Joc.lM?
Sueet Cffy
qS-l- 5 > -"3-S '1 f
Phone: &n) b:'5"4 4D2
Cf>., • 9 2--.c2? :3
State Zip
Mailing address (ifdifferentJ--
Street City State Zip
If more than one Plaintiff, list next Plaintiff here:
Name: Phone: LJ _
Street address:
Street City State Zip
Mailing address (ifdifferentJ---=--:- =- --::--:-__--=.,...- _
Street City State Zip
D Check here ifmore than 2 Plaintiffs and attach Form SC-100A.
o Check here ifeither Plaintifflisted above is doing business under afictitious name. Ifso, attach Form SC-103.
o The Defendant (the person, business, or public entity being sued) is:
Name: ABC EscrowABC Escrow
Street address: J] 3 '23 SUI'/\SeJ.. jS\vJ. su;le. f\ 3 \ 0 Pa.AH"C Pa.\,·sodes . cA. 'I e2 7;.
Street • City State Zip ,
Mailing address (ifdifferent):
Street City State Zip
If more than one Defendant, list next Defendant here:
Name: Phone: L-) _
Street address: -=--:- -= ;::-;-; -::;:- _
Street City State Zip
Mailing address (ifdifferent):
Street City State Zip
D Check here ifmore than 2 Defendants and attach Form SC-100A.
D Check here ifany Defendant is on active military duty, and write his or her name here: _
o The Plaintiff claims the Defendant owes $ 7rsm.- . (Explain below): •
a. Why does the Defendant owe the Plaintiff money? Opened escrow on a liquor license with

ABC Escrow and Escrow never went through. ABC Escrow does not want to return my money.
t=:sc-et2uJ of\. 9.L;Ql?\AK
LtcE!..\'\se.
t\
b. When did this happen? (Date): --ltPo lJ'}L1OI..f
If no specific date, give the time period: Date started: Through: (? _
c. How did you calculate the money owed to you? (Dr; not include court costs orfees for service.) _
_ r'n
"" • - I.
D Chelk fIJi!::-clt space.
the top.
Revised January 1, 2006
Plaintiff's Claim and ORDER
to Go to Small Claims Court
(Small Claims)
SC-100, Page 2 of 5
-+
..
Plaintiff (list names):
ICase Number.
o You must ask the Defendant (in person, in writing, or by phone) to pay you before you sue.
Have you done this? I0"Yes D No
Ifno, explain why not: _
® Why are you filing your claim at this courthouse?
This courthouse covers the area (check the one that
a. 0"(1) Where the Defendant lives or does business. a contract (written or spoken) was made,
(2) Where the Plaintiffs property was damaged. signed, performed, or broken by the Defendant or
(3) Where the Plaintiff was injured. where the Defendant lived or did business when
the Defendant made the contract.
b. D Where the buyer or lessee signed the contract, lives now, or lived when the contract was made, if this claim
is about an offer or contract for personal, family, or household goods, services, or loans. (Code Civ. Proc.,
§ 395(b).)
c. D Where the buyer signed the contract, lives now, or lived when the contract was made, if this claim is about
a retail installment contract (like a credit card). (Civil Code, § 1812.10.)
d. D Where the buyer signed the contract, lives now, or lived when the contract was made, or where the vehicle
is permanently garaged, ifthis claim is about a vehicle finance sale. (Civil Code, § 2984.4.)
e. D Other (specify): _
(!) List the zip code of the place checked in ® above (ifyou
()) Is your claim about an attorney-client fee dispute? DYes I&No
Ifyes, and ifyou have had arbitration, fill out Form SC-101, attach it to thisform, and check here: D
CD Are you SUing a public entity? 0 Yes No
Ifyes, you mustfile a written claim with the entityfirst. D A claim was filed on (date): _
Ifthe public entity denies your claim or does not answer within the time allowed by law, you can file this form.
eD Have you filed more than 12 other small claims within the last 12 months in California?
D Yes Ifyes, thefilingfeefor this case will be higher.
Plamti

PlaintifJtypes or prints name here
Date: 4./Jlob
Date:
@ I understand that by filing a claim in small claims court:
• I have no right to appeal this claim and
• I cannot file, and have not filed, more than two small claims cases for more than $2,500 in California
during this calendar year.
I declare, under penalty of perjury under California State law, that the information ab e and correct.
Second PlaintifJtypes or prints name here Second PlaintifJsigns here
rj
Requests for Accommodations
• .•• •Assistive listening systems, cnmputer-assisted, real-time captioning, or sign language interpreter
services are available if you ask at least 5 days before the trial. Contact the clerk's office for Form
MC-410, Request for Accommodations by Persons With Disabilities and Order. (Civil Code, § 54.8.)
Revised January 1, 2006
Plaintiff's Claim and ORDER
to Go to Small Claims Court
(Small Claims)
SC-100, Page 3 of 5
-+

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