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MC-350: MC 350 Form | CA Small Claims
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MC-350
Miscellaneous
Fillable PDF
MC 350 Form
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1
p1_caption_sf
Atty Bar No Dc
Atty Name Ft
Atty Firm Ft
Atty Street Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Atty City Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Atty State Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Atty Zip Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Phone Ft
Fax Ft
Email Ft
Atty For Ft
Crt County Ft
Street Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Mailing Add Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
City Zip Ft
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
DC
Branch Ft
Case Number Ft
Case Name Ft
Hearing Date Time Ft
Hearing Dept Ft
Hearing Time Ft
2
list
fill text 19
check box 6
check box 7
check box 8
check box 9
fill text 25
check box 12
Claimant Name
Hearing Date Ff
Clm Dob
fill text 23
check box 4
check box 5
Field 14
Field 15
Not Subj Of Claim Cb
Subj Of C Laim Sb
Settl Amount
$
Pending Case No
Pending Case Date
Cb Choice1 Cb
Settl Amount
$
Field 23
Addl Def Of Cb
Disb Of Cb
Judgment Date
Hearing Date Ff
Hearing Time Ff
Incident Place
Field 30
Incident Of Cb
fill text 43
Inci Desc Of Cb
Field 34
Injuries Of Cb
Field 36
Treatment Of Cb
Recovery Cb
Recovery Cb
Text Field
Disb Of Cb
Cb Choice1 Cb
Text Field
Disb Of Cb
Disb Of Cb
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
check box 43
fill text 69
check box 44
check box 45
check box 46
check box 47
check box 48
fill text 70
check box 49
Check Bo
fill text 71
check box 50
check box 51
Field 64
check box 52
fill text 73
check box 123
fill text 76
fill text 88
fill text 78
check box 54
Field 72
check box 55
check box 120
Not Clm Filed T
check box 53
Field 77
check box 121
fill text 80
check box 122
check box 56
check box 57
fill text 81
Field 84
check box 58
fill text 82
fill text 83
fill text 84
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Field 91
fill text 89
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fill text 97
Field 100
Field 101
Field 102
Field 103
Field 104
Field 105
check box 59
Settl Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Oth Exp Items
Other Exp Payee
Oth Exp Amount
$
Settlement Def Cb
Oth Exp Total
check box 65
Field 135
Check Bo
Check Bo
fill text 148
fill text 149
fill text 150
fill text 151
fill text 152
Field 143
Check Bo
Check Bo
fill text 154
fill text 155
fill text 153
fill text 156
fill text 157
fill text 158
fill text 159
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fill text 161
fill text 162
fill text 163
fill text 164
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fill text 166
fill text 167
check box 68
Check Bx
Check Bx
check box 70
Field 165
Check Bx
Check Bx
fill text 169
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fill text 178
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fill text 180
fill text 181
fill text 182
check box 72
check box 83
check box 90
Field 186
check box 91
No Grdnshp Dispo Cb
Amount
$
No Grdnshp Dispo Cb
Amount
$
No Grdnshp Dispo Cb
Amount
$
Cty Name
No Grdnshp Dispo Cb
Amount
$
check box 97
fill text 210
check box 98
Addl Orders Cb
Addl Orders
Addl Order Of Cb
check box 11
Date
Print Name
Pp Att
3
footer_sub
Button
4
px_caption_sf
Case Name Ft
Case Number Ft
Case Name Ft
Case Number Ft
Case Name Ft
Case Number Ft
Case Name Ft
Case Number Ft
Case Name Ft
Case Number Ft
Case Name Ft
Case Number Ft
5
xxx_fix
Settl Amount
$
Field 2
Settl Amount
$
Field 4
Settl Amount
$
Field 6
Settl Amount
$
Field 8
Settl Amount
$
Disb Of Cb
6
list12_xxx_fix
Text Field
Disb Of Cb
Settlement Pay To Others Cb
Settlement Pay To Others Cb
Settl Amount
$
check box 39
Field 7
check box 40
Field 9
Settlement Def Cb
Field 11
Settl Amount
$
Field 13
Settl Amount
$
Field 15
Settl Amount
$
Field 17
Settl Amount
$
Disb Of Cb
7
title_party_name
Case Name Ft
8
case_number
Case Number Ft
9
p
Case Name Ft
Case Number Ft
Health Plan Cb
Health Plan Cb
Settlement Def Cb
Settl Amount
$
Settlement Def Cb
Settl Amount
$
Settlement Def Cb
Settl Amount
$
Oth Exp Total
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
Settl Amount
$
Case Name Ft
Case Number Ft
Grdnshp Cb
Grdnshp Crt
Grdnshp Case No
Proceeds To Grdn Cb
Settl Amount
$
Proceed To Pet Dep Cb
Settl Amount
$
Proceednot Grdn Cb
Not Estate Dep Cb
Dep Acts Amount
$
Not Estate Inv Cb
Inv Amount
$
Not Estate Tfr Cb
Tfr Amount
$
check box 80
fill text 192
check box 81
check box 82
fill text 193
No Grdnshp Cb
No Grdnshp Dispo Cb
Amount
$
No Grdnshp Dispo Cb
Amount
$
No Grdnshp Dispo Cb
Amount
$
check box 87
fill text 197
No Grdnshp Dispo Cb
Amount
$
No Grdnshp Dispo Cb
Amount
$
10
sign_sub
Date
Print Name
Date
Print Name
11
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