ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

UD-101

STATE:

FAX NO.:

ZIP CODE:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PLAINTIFF:

DEFENDANT:

All plaintiffs in unlawful detainer proceedings must file and serve this form. Filing this form complies with the requirement in Code of 
Civil Procedure section 1179.01.5(c).  
     • Serve this form and any attachments to it with the summons.   
     • If a summons has already been served without this form, then serve it by mail or any other means of service authorized by law. 
     • If defendant has answered prior to service of this form, there is no requirement for defendant to respond to the supplemental  
       allegations before trial. 

o obtain a judgment in an unlawful detainer action for nonpayment of rent on a residential property, a plaintiff must verify that no 

rental assistance or other financial compensation has been received for the amount demanded in the notice or accruing afterward, and 
that no application is pending for such assistance. To obtain a default judgment, plaintiff must use Verification by Landlord Regarding 
Rental Assistance—Unlawful Detainer (form UD-120) to make this verification and provide other information required by statute.

  T

1.   PLAINTIFF (name each):

PLAINTIFF'S MANDATORY COVER SHEET AND  
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

CASE NUMBER:

alleges causes of action in the complaint filed in this action against DEFENDANT (name each):

2.  Statutory cover sheet allegations (Code Civ. Proc., § 1179.01.5(c))

a. This action seeks possession of real property that is (check all that apply):

Residential

Commercial

(If "residential" is checked, complete items 3 and 4 and all remaining items that apply to this action. If only "commercial" is 
checked, no further items need to be completed except the signature and verification on page 5; a summons may be issued.)

b. This action is based, in whole or in part, on an alleged default in payment of rent or other charges.

Yes

No

3.

Item 3 has been removed as it only applied before July 1, 2022.

THIS SPACE INTENTIONALLY LEFT BLANK

Form Adopted for Mandatory Use 
Judicial Council of California 
UD-101 [Rev. July 16, 2022]

PLAINTIFF'S MANDATORY COVER SHEET AND 
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

Page 1 of 5

Code of Civil Procedure, § 1179.01 et seq.

www.courts.ca.gov

PLAINTIFF:

DEFENDANT:

CASE NUMBER:

UD-101

THIS SPACE INTENTIONALLY LEFT BLANK

4. Tenants subject to COVID-19 Tenant Relief Act (Code Civ. Proc., § 1179.02(h))

a.

(1) One or more defendants in this action is a natural person:
(2) Identify any defendant not a natural person:
(If no is checked, then no further items need to be completed except the signature and verification, and item 12 if the action is 
based on nonpayment of rent.)

Yes

No

b.

(1) All defendants named in this action maintain occupancy as described in Civil Code section 1940(b):

Yes

No

(2) Identify any defendant who does not:

5.

6.

(If yes is checked, then no further items need to be completed except the signature and verification, and item 12 if the action is 
based on nonpayment of rent.)

Unlawful detainer notice expired before March 1, 2020 
The unlawful detainer complaint in this action is based solely on a notice to quit, to pay or quit, or to perform covenants or 
quit, in which the time period specified in the notice expired before March 1, 2020. (If this is the only basis for the action, no 
further items need to be completed except the signature and verification on page 5. (Code Civ. Proc., § 1179.03.5(a)(1).))

Rent or other financial obligations due between March 1, 2020, and August 31, 2020 (protected time period) 
The unlawful detainer complaint in this action is based, at least in part, on a demand for payment of rent or other financial 
obligations due in the protected time period. (Check all that apply.)

a.

Defendant (name each):

b.

Defendant (name each):

was provided all the required versions of the "Notice from the State of California" required by Code of Civil Procedure section 
1179.04. (Provide information regarding service of the notice or notices in item 8 below.)

was served with at least 15 days' notice to pay rent or other financial obligations, quit, or deliver a declaration, and an unsigned 
declaration of COVID-19–related financial distress, in the form and with the content required in Code of Civil Procedure section 
1179.03(b) and (d). 

(If the notice identified defendant as a high-income tenant and requested submission of documentation supporting any 
declaration the defendant submits, complete item 9 below. (Code Civ. Proc., § 1179.02.5(c).))

(If filing form UD-100 with this form and item 6b is checked, specify this 15-day notice in item 9a(7) on form UD-100, attach 
a copy of the notice to that complaint form, and provide all requested information about service on that form.)

UD-101 [Rev. July 16, 2022]

PLAINTIFF'S MANDATORY COVER SHEET AND  
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

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PLAINTIFF:

DEFENDANT:

6. c. Response to notice (check all that apply):

(1)

Defendant (name each):

CASE NUMBER:

UD-101

delivered a declaration of COVID-19–related financial distress on landlord in the time required. (Code Civ. Proc.,  
§ 1179.03(f).)

(2)

Defendant

(name each):

did not deliver a declaration of COVID-19–related financial distress on landlord in the time required. (Code Civ. Proc.,  
§ 1179.03(f).)

7.

Rent or other financial obligations due between September 1, 2020, and September 30, 2021 (the transition time 
period) The unlawful detainer complaint in this action is based, at least in part, on a demand for payment of rent or other 
financial obligations due during the transition time period.

a.

Defendant (name each):

b.

Defendant (name each):

was provided all the required versions of the "Notice from the State of California"  as required by Code of Civil Procedure section 
1179.04. (Provide information regarding service of the notice or notices in item 8 below.)

was served with at least 15 days' notice to pay rent or other financial obligations, quit, or deliver a declaration, and an unsigned 
declaration of COVID-19  related financial distress, in the form and with the content required in Code of Civil Procedure  
section 1179.03(c) and (d). 

–

(If the notice identified defendant as a high-income tenant and requested submission of documentation supporting any 
declaration the defendant submits, complete item 9 below. (Code Civ. Proc., § 1179.02.5(c).))

(If filing form UD-100 with this form and item 7b is checked, specify this 15-day notice in item 9a(7) on form UD-100, attach 
a copy of the notice to that complaint form, and provide all requested information about service on that form.)

c. Response to notice (check all that apply):

(1)

Defendant (name each):

delivered a declaration of COVID-19–related financial distress on the landlord in the time required. (Code Civ. Proc., 
§ 1179.03(f).)

(2)

Defendant (name each):

did not deliver a declaration of COVID-19–related financial distress on the landlord in the time required. (Code Civ. Proc.,  
§ 1179.03(f).))

d.

Rent or other financial obligations due: 

(1) Rent or other financial obligations in the amount of $

was due between September 1, 2020, and

September 30, 2021.  

(2) Payment of $

for that period was received by September 30, 2021.

8. Service of Code of Civil Procedure Section 1179.04 Notice from the State of California (You must complete this item if you 
checked item 6 or 7 above.  Section 1179.04 provides three separate versions of a “Notice from the State of California” that the 
landlord was to provide to tenants at different times during the pandemic (the notices referenced in items 6a and 7a above). This 
item addresses when and how those notices were provided.)

a. September 2020 Notice.  Plaintiff provided the required notice for tenants who, as of September 1, 2020, had any unpaid rent 
or other financial obligations due any time between March 1, 2020, and August 31, 2020 (Code Civ. Proc., § 1179.04(a)), to 
defendants identified in 6a or as follows:

(1)

(2)

By sending a copy by mail addressed to each named defendant on (date):

By personally handing a copy to each named defendant on (date):

.

.

UD-101 [Rev. July 16, 2022]

PLAINTIFF'S MANDATORY COVER SHEET AND  
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

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PLAINTIFF:

DEFENDANT:

CASE NUMBER:

UD-101

.

.

.

.

8. a.

(3)

By some other method of service described in Code of Civil Procedure section 1162. (If this box is checked, describe 
the method and date of service on an attached page (you can use form MC-025) and title it Attachment 8a.)

In different ways for different defendants. (If this box is checked, describe the method and date of service for each 
defendant on an attached page (you can use form MC-025) and title it Attachment 8a.)

Plaintiff was not required to serve the September 2020 notice on the named defendants.

b. February 2021 Notice.  Plaintiff provided the required notice for tenants who as of February 1, 2021, had unpaid rent or other 
financial obligations due any time after March 1, 2020, (Code Civ. Proc., § 1179.04(b)) to defendants identified in 6a and 7a as 
follows:

By sending a copy by mail addressed to each named defendant on (date):

By personally handing a copy to each named defendant on (date):

By some other method of service described in Code of Civil Procedure section 1162. (If this box is checked, describe 
the method and date of service on an attached page (you can use form MC-025) and title it Attachment 8b.)

In different ways for different defendants. (If this box is checked, describe the method and date of service for each 
defendant on an attached page (you can use form MC-025) and title it Attachment 8b.)

Plaintiff was not required to serve the February 2021 notice on the named defendants.

c. July 2021 Notice.  Plaintiff provided the required notice for tenants who as of July 1, 2021, had unpaid rent or other financial 
obligations due any time after March 1, 2020, (Code Civ. Proc., § 1179.04(c)) to defendants identified in 6a and 7a as follows:

By sending a copy by mail addressed to each named defendant on (date):

By personally handing a copy to each named defendant on (date):

By some other method of service described in Code of Civil Procedure section 1162. (If this box is checked, describe 
the method and date of service on an attached page (you can use form MC-025) and title it Attachment 8c.)

In different ways for different defendants. (If this box is checked, describe the method and date of service for each 
defendant on an attached page (you can use form MC-025) and title it Attachment 8c.)

Plaintiff was not required to serve the July 2021 notice on the named defendants.

9.

a.

b.

10.

High-income tenant. The 15-day notice in item 6b or 7b above identified defendant as a high-income tenant and requested 
submission of documentation supporting the tenant's claim that tenant had suffered COVID-19–related financial distress. 
Plaintiff had proof before serving that notice that the tenant has an annual income that is at least 130 percent of the median 
income for the county the rental property is located in and not less than $100,000. (Code Civ. Proc., § 1179.02.5.)

The tenant did not deliver a declaration of COVID-19–related financial distress within the required time. (Code Civ. Proc.,  
§ 1179.03(f).)

The tenant did not deliver documentation within the required time supporting that the tenant had suffered COVID-19– 
related financial distress as asserted in the declaration. (Code Civ. Proc., § 1179.02.5(c).)

Rent or other financial obligations due between October 1, 2021, and March 31, 2022 (recovery period rental debt). 
The unlawful detainer complaint in this action is based, at least in part, on a demand for payment of rent or other financial 
obligations due during the recovery period. (Check a, b, or c.)

a.

Defendant (name each):

was served with at least 3 days' notice to pay rent or other financial obligations or quit, in a notice that included the information 
about the government rental assistance program and possible protections, as required by Code of Civil Procedure section 
1179.10. 

If filing form UD-100 with this form and this item is checked, specify this notice in item 9a(7) on form UD-100, attach a copy of 
the notice to that complaint form, and provide all requested information about service on that form.)

The tenancy was not initially established before October 1, 2021, and the special notice to quit required by Code of Civil 
Procedure section 1179.10 does not apply in this action.

The 3 days' notice to pay rent or other financial obligations or quit was served on or after July 1, 2022, and the special 
notice to quit required by Code of Civil Procedure section 1179.10 does not apply in this action.

  (

b.

c.

UD-101 [Rev. July 16, 2022]

PLAINTIFF'S MANDATORY COVER SHEET AND  
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

Page 4 of 5

(4)

(5)

(1)

(2)

(3)

(4)

(5)

(1)

(2)

(3)

(4)

(5)

CASE NUMBER:

UD-101

PLAINTIFF:

DEFENDANT:

11.

12.

Rent or other financial obligations due after March 31, 2022. (Only applicable if action is filed on or after April 1, 2022.) 
The only demand for rent or other financial obligations on which the unlawful detainer complaint in this action is based is a 
demand for payment of rent due after March 31, 2022.

Statements regarding rental assistance (Required in all actions based on nonpayment of rent or any other financial 
obligation. Plaintiff must answer all the questions in this item and, if later seeking a default judgment, will also need to file 
Verification Regarding Rental Assistance    Unlawful Detainer (form UD-120).) 

—

a. Has plaintiff received rental assistance or other financial compensation from any other source corresponding to the amount 
Yes

demanded in the notice underlying the complaint?   

No

b. Has plaintiff received rental assistance or other financial compensation from any other source for rent accruing after the date of 

the notice underlying the complaint? 

Yes

No

c. Does plaintiff have any pending application for rental assistance or other financial compensation from any other source 

corresponding to the amount demanded in the notice underlying the complaint? 

Yes

No

d. Does plaintiff have any pending application for rental assistance or other financial compensation from any other source for rent 

accruing after the date on the notice underlying the complaint? 

Yes

No

13. 

Other allegations Plaintiff makes the following additional allegations: (State any additional allegations below, with each 
allegation lettered in order, starting with (a), (b), (c), etc. If there is not enough space below, check the box below and use 
form MC-025, title it Attachment 13, and letter each allegation in order.) 

Other allegations are on form MC-025.

Number of pages attached  (specify):

14.

Date:

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PLAINTIFF OR ATTORNEY)

(Use a different verification form if the verification is by an attorney or for a corporation or partnership.)

VERIFICATION

I am the plaintiff in this proceeding and have read this complaint. 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)

UD-101 [Rev. July 16, 2022]

PLAINTIFF'S MANDATORY COVER SHEET AND  
SUPPLEMENTAL ALLEGATIONS—UNLAWFUL DETAINER

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