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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY:

STATE BAR NO:

FOR COURT USE ONLY

CIV-110

STATE:

FAX NO. :

ZIP CODE:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (Name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

Plaintiff/Petitioner:

Defendant/Respondent:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

REQUEST FOR DISMISSAL

CASE NUMBER:

A conformed copy will not be returned by the clerk unless a method of return is provided with the document.  

This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action in a  class 
action. (Cal. Rules of Court, rules 3.760 and 3.770.) 

1.

TO THE CLERK: Please dismiss this action as follows:
a.
b.

With prejudice 
Complaint

Without prejudice
Petition

(2)
(2)

(1)
(1)

(3)

(4)

(5)

(6)

Cross-complaint filed by (name):
Cross-complaint filed by (name):

Entire action of all parties and all causes of action

Other  (specify):*

on (date):

on (date):

2.

(Complete in all cases except family law cases.)
The court                                            waive court fees and costs for a party in this case. (This information may be obtained from  the 
clerk. If court fees and costs were waived, the declaration on the back of this form must be completed). 

did not

did

(TYPE OR PRINT NAME OF

ATTORNEY

PARTY WITHOUT ATTORNEY)

*If dismissal requested is of specified parties only of specified causes of action only, 
or of specified cross-complaints only, so state and identify the parties, causes of 
action, or cross-complaints to be dismissed.

(SIGNATURE)
Attorney or party without attorney for:

Plaintiff/Petitioner
Cross Complainant

Defendant/Respondent

3.  TO THE CLERK:  Consent to the above dismissal is hereby given.**

(TYPE OR PRINT NAME OF

ATTORNEY

PARTY WITHOUT ATTORNEY)

(SIGNATURE)

** If a cross-complaint – or Response (Family Law) seeking affirmative 
relief – is on file, the attorney for cross-complainant (respondent) must sign 
this consent if required by Code of Civil Procedure section 581 (i) or (j).

Attorney or party without attorney for:

Plaintiff/Petitioner
Cross Complainant

Defendant/Respondent

(To be completed by clerk)
4.

Dismissal entered as requested on  (date):
Dismissal entered on  (date):
Dismissal not entered as requested for the following reasons (specify):

as to only (name):

Attorney or party without attorney notified on (date): 
Attorney or party without attorney not notified. Filing party failed to provide
means to return conformed copy

a copy to be conformed

Form Adopted for Mandatory Use 
Judicial Council of California 
CIV-110 [Rev. Jan. 1, 2013]

Clerk, by

REQUEST FOR DISMISSAL

, Deputy

Page 1 of 2

Code of Civil Procedure, § 581 et seq.; Gov. Code,  
§ 68637(c); Cal. Rules of Court, rule 3.1390 
www.courts.ca.gov

Date:

Date:

.

5 6

7.

a.
b.

Date:

Plaintiff/Petitioner:

Defendant/Respondent:

CASE NUMBER:

CIV-110

COURT'S RECOVERY OF WAIVED COURT FEES AND COSTS 
If a party whose court fees and costs were initially waived has recovered or will recover $10,000 or more in 
value by way of settlement, compromise, arbitration award, mediation settlement, or other means, the 
court has a statutory lien on that recovery. The court may refuse to dismiss the case until the lien is 
satisfied. (Gov. Code, § 68637.)

Declaration Concerning Waived Court Fees

1.

The court waived court fees and costs in this action for (name):

2.

The person named in item 1 is (check one below): 

 not recovering anything of value by this action.

 recovering less than $10,000 in value by this action.
 recovering $10,000 or more in value by this action.  (If item 2c is checked, item 3 must be completed.) 

3.

All court fees and court costs that were waived in this action have been paid to the court  (check one):

Yes

No

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.

a.
b.
c.

Date:

(TYPE OR PRINT NAME OF 

ATTORNEY

PARTY MAKING DECLARATION)

(SIGNATURE)

CIV-110 [Rev. January 1, 2013]

REQUEST FOR DISMISSAL

Page 2 of 2

Request for Dismissal

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 74
Average fields per page: 37
Reading Level: Grade 7
LIST Grouping(s): CO-07-00-00-00, CO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

topmost_subform_page_plaintiff__1 was topmostSubform[0].Page1[0].Plaintiff1[0] (0.60 conf)
topmost_page_defendant__1 was topmostSubform[0].Page1[0].Defendant1[0] (0.38 conf)
topmost_page_complainant__1 was topmostSubform[0].Page1[0].CrossComplainant1[0] (0.37 conf)
topmost_subform_page__1 was topmostSubform[0].Page1[0].T303[0] (0.38 conf)
topmost_subform_page_prejudice was topmostSubform[0].Page1[0].withPrejudice[0] (0.40 conf)
page_without_prejudice was topmostSubform[0].Page1[0].withoutPrejudice[0] (0.40 conf)
topmost_page_complaint was topmostSubform[0].Page1[0].Complaint[0] (0.38 conf)
topmost_subform_page_petition was topmostSubform[0].Page1[0].Petition[0] (0.38 conf)
topmost_subform_page_crosscomplaint__1 was topmostSubform[0].Page1[0].Crosscomplaint1[0] (0.38 conf)
topmost_subform_page_name__1 was topmostSubform[0].Page1[0].Name1[0] (0.38 conf)
topmost_subform_page_date__1 was topmostSubform[0].Page1[0].date2[0] (0.40 conf)
topmost_subform_page_crosscomplaint__2 was topmostSubform[0].Page1[0].Crosscomplaint2[0] (0.38 conf)
topmost_subform_page_name__2 was topmostSubform[0].Page1[0].Name2[0] (0.38 conf)
topmost_subform_page_date__2 was topmostSubform[0].Page1[0].Date2[0] (0.38 conf)
topmost_page_entire_action was topmostSubform[0].Page1[0].EntireAction[0] (0.36 conf)
topmost_subform_page__2 was topmostSubform[0].Page1[0].Other[0] (0.38 conf)
topmost_subform_page_specify was topmostSubform[0].Page1[0].Specify[0] (0.38 conf)
topmost_subform_page_sig_date__1 was topmostSubform[0].Page1[0].SigDate1[0] (0.41 conf)
topmost_subform_page_sig_name__1 was topmostSubform[0].Page1[0].SigName1[0] (0.41 conf)
topmost_subform_page_sig_atty__1 was topmostSubform[0].Page1[0].SigAtty1[0] (0.41 conf)
topmost_subform_page_sig_party__1 was topmostSubform[0].Page1[0].SigParty1[0] (0.41 conf)
topmost_page_entered_req was topmostSubform[0].Page1[0].DismEnteredReq[0] (0.44 conf)
topmost_page_enter_req_date was topmostSubform[0].Page1[0].DismEnterReqDate[0] (0.33 conf)
topmost_subform_page_dism_entered__1 was topmostSubform[0].Page1[0].DismEntered[0] (0.44 conf)
topmost_subform_page_enter_date was topmostSubform[0].Page1[0].DismEnterDate[0] (0.35 conf)
topmost_subform_page_name__3 was topmostSubform[0].Page1[0].AsToName[0] (0.45 conf)
topmost_subform_page_dism_entered__2 was topmostSubform[0].Page1[0].DismNotEntered[0] (0.40 conf)
topmost_page_enter_specify was topmostSubform[0].Page1[0].DismNotEnterSpecify[0] (0.38 conf)
topmost_subform_page_notification__1 was topmostSubform[0].Page1[0].Notification[0] (0.38 conf)
topmost_notification_date was topmostSubform[0].Page1[0].NotificationDate[0] (0.40 conf)
topmost_subform_page_notification__2 was topmostSubform[0].Page1[0].NotificationNo[0] (0.40 conf)
topmost_page_copy_confirm was topmostSubform[0].Page1[0].NoCopyConfirm[0] (0.38 conf)
topmost_subform_page_meansto_return was topmostSubform[0].Page1[0].NoMeanstoReturn[0] (0.40 conf)
topmost_page_clerk_sig_date was topmostSubform[0].Page1[0].ClerkSigDate[0] (0.33 conf)
page_std_p_header_county was topmostSubform[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CrtCounty_ft[0] (0.40 conf)
page_std_p_header_info__1 was topmostSubform[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Branch_ft[0] (0.42 conf)
page_std_p_header_info_city__1 was topmostSubform[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].CityZip_ft[0] (0.42 conf)
page_std_p_header_info__2 was topmostSubform[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].Street_ft[0] (0.42 conf)
page_std_p_header_info__3 was topmostSubform[0].Page1[0].StdP1Header_sf[0].CourtInfo[0].MailingAdd_ft[0] (0.42 conf)
topmost_subform_page_std_p_header_sf_title_party_name_ft__1 was topmostSubform[0].Page1[0].StdP1Header_sf[0].TitlePartyName[0].Party1_ft[0] (0.42 conf)
topmost_subform_page_std_p_header_sf_title_party_name_ft__2 was topmostSubform[0].Page1[0].StdP1Header_sf[0].TitlePartyName[0].Party2_ft[0] (0.42 conf)
page_std_p_header_number was topmostSubform[0].Page1[0].StdP1Header_sf[0].CaseNumber[0].CaseNumber_ft[0] (0.39 conf)
page_std_p_header_sf_info__1 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyState_ft[0] (0.43 conf)
page_std_p_header_info_zip was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyZip_ft[0] (0.39 conf)
page_std_p_header_info_city__2 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyCity_ft[0] (0.44 conf)
page_std_p_header_info__4 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyStreet_ft[0] (0.45 conf)
page_std_p_header_sf_info__2 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyFirm_ft[0] (0.42 conf)
page_std_p_header_info_name was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyName_ft[0] (0.42 conf)
page_std_p_header_info_dc was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyBarNo_dc[0] (0.39 conf)
page_std_p_header_info_phone was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].Phone_ft[0] (0.41 conf)
page_std_p_header_sf_info__3 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].Fax_ft[0] (0.41 conf)
page_std_p_header_info_email was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].Email_ft[0] (0.41 conf)
page_std_p_header_sf_info__4 was topmostSubform[0].Page1[0].StdP1Header_sf[0].AttyInfo[0].AttyFor_ft[0] (0.43 conf)
topmost_subform_page_sig_date__2 was topmostSubform[0].Page1[0].SigDate2[0] (0.41 conf)
topmost_subform_page_sig_name__2 was topmostSubform[0].Page1[0].SigName2[0] (0.41 conf)
topmost_subform_page_sig_atty__2 was topmostSubform[0].Page1[0].SigAtty2[0] (0.41 conf)
topmost_subform_page_sig_party__2 was topmostSubform[0].Page1[0].SigParty2[0] (0.41 conf)
topmost_subform_page_plaintiff__2 was topmostSubform[0].Page1[0].Plaintiff2[0] (0.38 conf)
topmost_page_defendant__2 was topmostSubform[0].Page1[0].Defendant2[0] (0.38 conf)
topmost_page_complainant__2 was topmostSubform[0].Page1[0].CrossComplainant2[0] (0.37 conf)
topmost_subform_page_f_w_name was topmostSubform[0].Page2[0].FW\.01\.name[0] (0.38 conf)
topmost_page_f_w_choice__1 was topmostSubform[0].Page2[0].FW\.02\.choice[0] (0.38 conf)
topmost_page_f_w_choice__2 was topmostSubform[0].Page2[0].FW\.02\.choice[1] (0.38 conf)
topmost_page_f_w_choice__3 was topmostSubform[0].Page2[0].FW\.02\.choice[2] (0.38 conf)
topmost_subform_page_f_w_check was topmostSubform[0].Page2[0].FW\.03\.check[0] (0.38 conf)
topmost_subform_page_f_w_signature_date was topmostSubform[0].Page2[0].FW\.signature\.date[0] (0.38 conf)
page_f_w_signature_name was topmostSubform[0].Page2[0].FW\.signature\.name[0] (0.38 conf)
topmost_page_f_w_attorney was topmostSubform[0].Page2[0].FW\.attorney[0] (0.38 conf)
topmost_subform_page_fw_choice__1 was topmostSubform[0].Page2[0].fw\.03\.choice[0] (0.40 conf)
topmost_subform_page_fw_choice__2 was topmostSubform[0].Page2[0].fw\.03\.choice[1] (0.40 conf)
topmost_subform_page_fw_party was topmostSubform[0].Page2[0].fw\.party[0] (0.40 conf)
topmost_subform_page_header_gp_case_number_ft was topmostSubform[0].Page2[0].Header_gp[0].CaseNumber[0].CaseNumber_ft[0] (0.39 conf)
page_title_party_name_ft__1 was topmostSubform[0].Page2[0].Header_gp[0].TitlePartyName[0].Party1_ft[0] (0.42 conf)
page_title_party_name_ft__2 was topmostSubform[0].Page2[0].Header_gp[0].TitlePartyName[0].Party2_ft[0] (0.42 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

topmost_page_defendant__1
topmost_page_complainant__1
topmost_page_defendant__2
topmost_page_complainant__2

Suggested Screen 1:

page_without_prejudice

Suggested Screen 2:

topmost_subform_page_plaintiff__1
topmost_subform_page__1
topmost_subform_page_crosscomplaint__1
topmost_subform_page_name__1
topmost_subform_page_crosscomplaint__2
topmost_subform_page_name__2
topmost_subform_page__2
topmost_subform_page_sig_atty__1
topmost_subform_page_dism_entered__1
topmost_subform_page_name__3
topmost_subform_page_dism_entered__2
topmost_subform_page_meansto_return
topmost_subform_page_sig_atty__2
topmost_subform_page_plaintiff__2
topmost_subform_page_fw_choice__1
topmost_subform_page_fw_choice__2

Suggested Screen 3:

topmost_page_entire_action

Suggested Screen 4:

topmost_subform_page_prejudice
topmost_subform_page_petition
topmost_subform_page_specify
topmost_subform_page_enter_date
topmost_subform_page_fw_party

Suggested Screen 5:

topmost_subform_page_date__1
topmost_subform_page_date__2
topmost_subform_page_sig_date__1
topmost_subform_page_sig_name__1
topmost_subform_page_sig_party__1
topmost_subform_page_notification__1
topmost_subform_page_notification__2
topmost_page_clerk_sig_date
topmost_subform_page_sig_date__2
topmost_subform_page_sig_name__2
topmost_subform_page_sig_party__2
topmost_subform_page_header_gp_case_number_ft

Suggested Screen 6:

topmost_page_complaint
topmost_page_enter_req_date
topmost_page_enter_specify
topmost_page_copy_confirm

Suggested Screen 7:

topmost_notification_date

Suggested Screen 8:

page_std_p_header_county
page_std_p_header_info__1
page_std_p_header_info_city__1
page_std_p_header_info__2
page_std_p_header_info__3
page_std_p_header_number
page_std_p_header_sf_info__1
page_std_p_header_info_zip
page_std_p_header_info_city__2
page_std_p_header_info__4
page_std_p_header_sf_info__2
page_std_p_header_info_name
page_std_p_header_info_dc
page_std_p_header_info_phone
page_std_p_header_sf_info__3
page_std_p_header_info_email
page_std_p_header_sf_info__4

Suggested Screen 9:

topmost_subform_page_std_p_header_sf_title_party_name_ft__1
topmost_subform_page_std_p_header_sf_title_party_name_ft__2
topmost_subform_page_f_w_name
topmost_subform_page_f_w_check
topmost_subform_page_f_w_signature_date
page_f_w_signature_name

Suggested Screen 10:

topmost_page_entered_req
topmost_page_f_w_choice__1
topmost_page_f_w_choice__2
topmost_page_f_w_choice__3
topmost_page_f_w_attorney

Suggested Screen 11:

page_title_party_name_ft__1
page_title_party_name_ft__2

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Request for Dismissal

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02