Santa Barbara — SC-500A*

Source: https://www.courts.ca.gov/documents/sc500a.pdf

Case Number: Other Plaintiffs or Defendants SC-500A (COVID-19 Rental Debt)

This form is attached to form SC-500, item 1 or 2.

1 If more than two plaintiffs (person, business, or entity suing), list their information below: Other plaintiff’s name: Phone: Street address: Street City State Zip Mailing address (if different): Street City State Zip Email address (if available): Is this plaintiff doing business under a fictitious name? Yes No If yes, attach form SC-103. Other plaintiff’s name: Phone: Street address: Street City State Zip Mailing address (if different): Street City State Zip Email address (if available): Is this plaintiff doing business under a fictitious name? Yes No If yes, attach form SC-103. Check here if more than four plaintiffs and fill out and attach another form SC-500A.

2 If more than two defendants (person being sued), list their information below: Other defendant’s name: Phone: Street address: Street City State Zip Mailing address (if different): Street City State Zip Other defendant’s name: Phone: Street address: Street City State Zip Mailing address (if different): Street City State Zip Check here if your case is against more than four defendants and fill out and attach another form SC-500A. 3 I understand that by filing a claim in small claims court, I have no right to appeal this claim.

I declare under penalty of perjury under the laws of the State of California that the information above and on any attachments to this form is true and correct. Date:

Type or print your name Sign your name

Date:

Type or print your name Sign your name

Judicial Council of California, www.courts.ca.govAdopted November 1, 2021, Mandatory Form Other Plaintiffs or Defendants SC-500A, Page of Code of Civil Procedure, § 116.223 et seq. (COVID-19 Rental Debt) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form