PARTY (Name & Address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 th West - 8141 13 Street, Westminster, CA 92683-4593 PLAINTIFF: DEFENDANT: CASE NUMBER: REQUEST FOR DISMISSAL (SMALL CLAIMS) HEARING DATE: TO THE CLERK: Please dismiss (check one box): Entire Action Plaintiff's Claim and ORDER to Go to Small Claims Court only Defendant's Claim and ORDER to Go to Small Claims Court only As follows (check one box): With Prejudice (You cannot sue again on the same cause of action.) Without Prejudice (You can sue again on the same cause of action.) Dated: Signature of Plaintiff If a Defendant's Claim and ORDER to Go to Small Claims Court has been filed, the defendant must also sign to dismiss entire action. Dated: Signature of Defendant Approved for Optional Use Form L-1203 (Rev. July 1, 2013) REQUEST FOR DISMISSAL (SMALL CLAIMS) Code of Civil Procedure 581 www.occourts.org American LegalNet, Inc. www.FormsWorkFlow.com