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

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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

PLD-C-520

FOR COURT USE ONLY

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

VERIFICATION BY PLAINTIFF REGARDING RENTAL 
ASSISTANCE—RECOVERY OF COVID-19 RENTAL DEBT

CASE NUMBER:

This form must be filed by the plaintiff with any request for default judgment in any legal action to recover rent or other financial 
obligations under a lease or rental agreement that accrued between April 1, 2020, and September 30, 2021. (See Health & Saf. 
Code, § 50897.3(e).) It may also be used at other times as appropriate or when requested by a judicial officer.

landlord for the tenancy for which the rent or other financial obligations are owed.

assignee or representative of the landlord for the tenancy for which the rent or other financial obligations are owed. (If 
checked, complete the items below.)

(1) Name of landlord:

(2) Plaintiff's relationship to landlord (describe):

2. 

Plaintiff states that the following are true:

The landlord has not received rental assistance or other financial compensation from any other source corresponding to 
the amount claimed.

The landlord does not have any pending application for rental assistance or other financial compensation from any other 
source corresponding to the amount claimed.

(Complete if plaintiff is not the landlord.)
Plaintiff can make the statements above on the following basis (describe the basis for plaintiff making the statements in a and b 
under penalty of perjury):

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF:

DEFENDANT:

1. 

Plaintiff (name):
is (check one)

a.

b.

a.

b.

c.

Date:

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

(TYPE OR PRINT NAME)

(SIGNATURE)

(TITLE—Provide if signing on behalf of corporation or other business entity)

Form Adopted for Mandatory Use 
Judicial Council of California 
PLD-C-520 [New November 1, 2021]

VERIFICATION BY PLAINTIFF REGARDING RENTAL  
ASSISTANCE—RECOVERY OF COVID-19 RENTAL DEBT 

Page 1 of 1

Health & Safety Code, § 50897.3(e)

Verification by Plaintiff Regarding Rental Assistance—Recovery of COVID-19 Rental Debt

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): 30
Average fields per page: 30
Reading Level: Grade 8
LIST Grouping(s): HO-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.

c_page_p_caption_case_number was PLD-C-520[0].Page1[0].P1Caption[0].CaseNumber[0].CaseNumber[0] (0.50 conf)
c_page_p_party_info_bar was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyBarNo[0] (0.39 conf)
c_page_p_party_info_name was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Name[0] (0.33 conf)
c_page_p_party_info_firm was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyFirm[0] (0.39 conf)
c_page_p_party_info_street was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Street[0] (0.33 conf)
c_page_p_party_info_city was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].City[0] (0.33 conf)
c_page_p_party_info_state was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].State[0] (0.33 conf)
pl_c_page_p_caption_atty_party_info_zip was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Zip[0] (0.33 conf)
c_page_p_party_info_phone was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Phone[0] (0.33 conf)
c_page_p_caption_party_info__1 was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Fax[0] (0.33 conf)
c_page_p_party_info_email was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Email[0] (0.33 conf)
c_page_p_caption_party_info__2 was PLD-C-520[0].Page1[0].P1Caption[0].AttyPartyInfo[0].AttyFor[0] (0.39 conf)
pl_c_page_p_caption_court_info_crt_county was PLD-C-520[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCounty[0] (0.34 conf)
pl_c_page_p_caption_court_info_crt_street was PLD-C-520[0].Page1[0].P1Caption[0].CourtInfo[0].CrtStreet[0] (0.34 conf)
c_page_p_caption_court_info was PLD-C-520[0].Page1[0].P1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.37 conf)
pl_c_page_p_caption_court_info_crt_city_zip was PLD-C-520[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCityZip[0] (0.34 conf)
c_page_p_court_info_branch was PLD-C-520[0].Page1[0].P1Caption[0].CourtInfo[0].CrtBranch[0] (0.34 conf)
c_page_p_title_party_name__1 was PLD-C-520[0].Page1[0].P1Caption[0].TitlePartyName[0].Party1[0] (0.33 conf)
c_page_p_title_party_name__2 was PLD-C-520[0].Page1[0].P1Caption[0].TitlePartyName[0].Party2[0] (0.33 conf)
pl_c_page_list_text_field was PLD-C-520[0].Page1[0].List1[0].TextField1[0] (0.34 conf)
pl_c_page_list_lia_check_box__1 was PLD-C-520[0].Page1[0].List1[0].Lia[0].CheckBox1[0] (0.36 conf)
pl_c_page_list_lib_check_box__1 was PLD-C-520[0].Page1[0].List1[0].Lib[0].CheckBox1[0] (0.36 conf)
pl_c_page_list_lib_sub_li_text_field__1 was PLD-C-520[0].Page1[0].List1[0].Lib[0].SubLib[0].Li1[0].TextField2[0] (0.38 conf)
pl_c_page_list_lib_sub_li_text_field__2 was PLD-C-520[0].Page1[0].List1[0].Lib[0].SubLib[0].Li2[0].TextField3[0] (0.38 conf)
pl_c_page_list_lia_check_box__2 was PLD-C-520[0].Page1[0].List2[0].Lia[0].CheckBox3[0] (0.36 conf)
pl_c_page_list_lib_check_box__2 was PLD-C-520[0].Page1[0].List2[0].Lib[0].CheckBox4[0] (0.36 conf)
pl_c_page_list_lic_text_field was PLD-C-520[0].Page1[0].List2[0].Lic[0].TextField5[0] (0.34 conf)
pl_c_page_sign_sig_date was PLD-C-520[0].Page1[0].Sign[0].SigDate[0] (0.32 conf)
pl_c_page_sign_sig_name__1 was PLD-C-520[0].Page1[0].Sign[0].SigName[0] (0.32 conf)
pl_c_page_sign_sig_name__2 was PLD-C-520[0].Page1[0].Sign[0].SigName1[0] (0.32 conf)

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

Verification by Plaintiff Regarding Rental Assistance—Recovery of COVID-19 Rental Debt

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

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