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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

UD-104

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF:

DEFENDANT:

Information for Defendant

A defendant tenant may use this form to file a declaration of COVID-19–related financial distress with the court if a plaintiff has filed
an unlawful detainer action against the defendant and asserts that a defendant did not deliver a declaration within the required 15-day
period after service of a notice demanding payment of rent or other financial obligations. (Code Civ. Proc., § 1179.03(h).)

or information about legal resources that may be available and to learn about other protections that may be available to you under

federal or local law, go to or .

• The signed declaration (you may use form UD-104(A)) must be filed within 5 days after the summons and legal papers in the
case are served on you, not counting Saturdays, Sundays, and other judicial holidays. This is the same time frame in which
you must file an answer or other response to the complaint.

• If the declaration is filed within the time frame described above, the case against you may be dismissed. The court will set a

hearing to determine if there was good cause for your not delivering the declaration to the plaintiff in the time required.

• The court will provide a notice of the time and place of the hearing to all plaintiffs and defendants.
• At the hearing, you may explain why you did not deliver this to the landlord in the time required.
• If the court finds that your failure to provide the declaration was due to mistake, inadvertence, surprise, or excusable
neglect, the court will dismiss the case against you.

• Written filings with the court must be provided in English. (Code Civ. Proc., §185 (a).)
• If attaching a non-English-language declaration provided by the landlord, you should also attach an English-language
version, either a copy that was given to you by the landlord or one from .
• You can attach a translation of the declaration instead, if signed by the translator.

COVER SHEET FOR DECLARATION OF
COVID-19–RELATED FINANCIAL DISTRESS

CASE NUMBER:

1. Defendant (name ):

has attached a declaration of COVID-19–related financial distress to this form, signed by defendant.

2. Number of pages attached, including signed declaration (specify):

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DEFENDANT OR ATTORNEY)

Form Approved for Optional Use
Judicial Council of California
UD-104 [New October 5, 2020]

COVER SHEET FOR DECLARATION OF
COVID-19–RELATED FINANCIAL DISTRESS

Code of Civil Procedure, § 1179.03(h)

Page 1 of 1

Cover Sheet for Declaration of Covid-19–Related Financial Distress

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): 1
Fields(s): 23
Average fields per page: 23
Reading Level: Grade 10
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.

u_page_p_caption_atty_party_info_bar was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyBarNo[0] (0.57 conf)
u_page_p_caption_atty_party_info_name was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Name[0] (0.39 conf)
u_page_p_caption_atty_party_info_firm was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyFirm[0] (0.41 conf)
u_page_p_caption_atty_party_info_street was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Street[0] (0.39 conf)
u_page_p_caption_atty_party_info_city was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].City[0] (0.39 conf)
u_page_p_caption_atty_party_info_state was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].State[0] (0.39 conf)
u_page_p_caption_atty_party_info_zip was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Zip[0] (0.39 conf)
u_page_caption_party_info_phone was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Phone[0] (0.39 conf)
u_page_p_caption_atty_party_info_fax was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Fax[0] (0.39 conf)
u_page_caption_party_info_email was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Email[0] (0.39 conf)
u_page_p_caption_atty_party_info was UD-104[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyFor[0] (0.41 conf)
u_page_caption_court_info_county was UD-104[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCounty[0] (0.43 conf)
u_page_caption_court_info_street was UD-104[0].Page1[0].P1Caption[0].CourtInfo[0].CrtStreet[0] (0.43 conf)
u_page_caption_court_info_add was UD-104[0].Page1[0].P1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.42 conf)
u_page_caption_court_info_branch was UD-104[0].Page1[0].P1Caption[0].CourtInfo[0].CrtBranch[0] (0.43 conf)
u_page_caption_court_info_city was UD-104[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCityZip[0] (0.38 conf)
u_page_caption_title_party_name__1 was UD-104[0].Page1[0].P1Caption[0].TitlePartyName[0].Party1[0] (0.39 conf)
u_page_caption_title_party_name__2 was UD-104[0].Page1[0].P1Caption[0].TitlePartyName[0].Party2[0] (0.39 conf)
u_page_p_caption_case_number was UD-104[0].Page1[0].P1Caption[0].CaseNumber[0].CaseNumber[0] (0.39 conf)
u_page_text_field__1 was UD-104[0].Page1[0].TextField2[0] (0.35 conf)
u_page_fill_text was UD-104[0].Page1[0].FillText56[0] (0.38 conf)
u_page_date_field was UD-104[0].Page1[0].DateField1[0] (0.31 conf)
u_page_text_field__2 was UD-104[0].Page1[0].TextField2[1] (0.35 conf)

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

Cover Sheet for Declaration of Covid-19–Related Financial Distress

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Identified Data Fields:

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