Approved for Optional Use
Form L-1203 (Rev. July 1, 2013)
REQUEST FOR DISMISSAL
(SMALL CLAIMS)
Code of Civil Procedure 581
www.occourts.org
PARTY (Name & Address):
TELEPHONE NO.: FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
FOR COURT USE ONLY
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
West - 8141 13
th
Street, Westminster, CA 92683-4593
PLAINTIFF:
DEFENDANT:
REQUEST FOR DISMISSAL
(SMALL CLAIMS)
CASE NUMBER:
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
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