Please rate Statement Damages Form Rev. July 1, 2025
Page 1 is the statement of damages and page 2 is the proof of service.
Defendant and plaintiff: name one defendant only and one plaintiff only.
Wrongful death only: loss of society and companionship, funeral expenses and future contributions are for wrongful death actions only.
Proof of service: after the other party is served, the person who served the documents completes it; the plaintiff cannot serve these papers.
Privacy: please press the Clear button after you have printed the form.
| Question | Answer |
|---|---|
| Form Name | Form CIV-050 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 163 |
| Avg. time to fill out | 28 min |
| Edition | July 1, 2025 |
| Issuing agency | Judicial Council of California |
| Filing | Do not file with the court unless applying for a default judgment under Code of Civil Procedure § 585 |
| Who signs | Plaintiff or attorney for plaintiff |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | CIV-050, CIV050, CIV 050, Statement of Damages, California Statement of Damages, Statement of Damages (Personal Injury or Wrongful Death) |
| Official source | Form CIV-050 (Rev July 1, 2025), Judicial Council of California |
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Please rate Statement Damages Form Rev. July 1, 2025
