SC-103 1 Case Number: Fictitious Business Name Form SC-100 OR Form SC-120 This form is attached to: If you want to file a small claim and you are doing business under a fictitious name ("doing business as," or "dba") give the following information. (Nonprofits and exempt real estate investment trusts do not have to file this form.) Business name of the person suing: Business address (not a U.S. Postal Service P.O. Box): Mailing address (if different): 2 The business listed in 1 does business as (check ONLY one): an individual an association a partnership a corporation a limited liability company other (specify): You must follow the laws for fictitious business names. If you have not followed these laws, including filing a fictitious business name statement in your county and publishing this information in a local newspaper, the court can dismiss your case. 3 Name of county where you filed your Fictitious Business Name Statement (dba): 4 5 Your Fictitious Business Name Statement number: Date your Fictitious Business Name Statement expires: 6 I declare, under penalty of perjury under California State law, that the information above is true and correct. Only the owner, president, chief executive officer (CEO), or other qualified officer can sign this form. Date: Type or print your name and title Sign your name ? Need help? Your county's Small Claims Advisor can help for free. Or go to "County-Specific Court Information" at: www.courtinfo.ca.gov/selfhelp/smallclaims Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2006, Optional Form Code of Civil Procedure, § 116.430; Business and Professions Code, § 17900 et seq. Fictitious Business Name (Small Claims) SC-103, Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com