APP-104 - Proposed Statement on Appeal (Limited Civil Case)

Summary

Proposed Statement on Appeal (Limited Civil Case)

Text

Form ID: APP-104
Title: Proposed Statement on Appeal (Limited Civil Case)
Effective Date: 2021-01-01
Mandatory Form: no
Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-104
Primary Download URL: https://www.courts.ca.gov/documents/app104.pdf
Form Detail Page:
Proposed Statement on Appeal (Limited Civil Case)
(APP-104)
Give the trial court and the other parties in an appeal in a limited civil case  your draft summary of the oral (spoken) proceedings in the case in the trial court (proposed statement on appeal). Use this form only if you are the appellant and you chose to use a statement or appeal in your notice designating the record on appeal. You must use this form if you are preparing a proposed statement on appeal and you are not represented by an attorney for the appeal.
Get form APP-104
Effective: January 1, 2021
Go to
How-to instructions for Appeals
Go to
Appeals Form Packets
PDF Text:
Judicial Council of California, www.courts.ca.gov 
Rev. January 1, 2021, Optional Form 
Cal. Rules of Court, rule 8.837
Proposed Statement on Appeal 
(Limited Civil Case)
APP-104 Proposed Statement on Appeal  
(Limited Civil Case)
Clerk stamps date here when form is filed.
You fill in the name and street address of the court 
that issued the judgment or order you are  
appealing:
Superior Court of California, County of
You fill in the number and name of the trial court  
case in which you are appealing the judgment or  
order:
Trial Court Case Number:
Trial Court Case Name:
You fill in the appellate division case number (if  
you know it):
Appellate Division Case Number:
Instructions
This form is only for preparing a proposed statement on appeal in a limited 
civil case.
Before you fill out this form, read Information on Appeal Procedures for 
Limited Civil Cases (form APP-101-INFO) to know your rights and 
responsibilities. You can get form APP-101-INFO at any courthouse or 
county law library or online at www.courts.ca.gov/forms.
This form can be attached to your Appellant’s Notice Designating Record 
on Appeal (Limited Civil Case) (form APP-103). If it is not attached to that  
notice, this form must be filed no later than 20 days after you file that 
notice. If you have chosen to prepare a statement on appeal and do not  
file this form on time, the court may dismiss your appeal.
Fill out this form and make a copy of the completed form for your records 
and for each of the other parties.
Serve a copy of the completed form on each of the other parties and keep  
proof of this service. You can get information about how to serve court  
papers and proof of service from What Is Proof of Service? (form  
APP-109-INFO) and on the California Courts Online Self-Help Center at 
www.courts.ca.gov/selfhelp-serving.htm.
Take or mail the original completed form and proof of service on the other  
parties to the clerk’s office for the same court that issued the judgment or  
order you are appealing. It is a good idea to take or mail an extra copy to the 
clerk and ask the clerk to stamp it to show that the original has been filed.
1 Your Information
a. Name of Appellant (the party who is filing this appeal):             
Name:
b. Appellant’s contact information (skip this if the appellant has a lawyer for this appeal):   
Street address: 
Street City State Zip
Mailing address (if different): 
Street City State Zip
Phone: Email:
c. Appellant’s lawyer (skip this if the appellant does not have a lawyer for this appeal):
Name: State Bar number:
Street address: 
Street City State Zip
Mailing address (if different): 
Street City State Zip
Phone: Email:
Fax:
APP-104, Page 1 of 7

Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
 Information About Your Appeal
2 On (fill in the date):  , I/my client filed a notice of appeal in the trial court case identified 
in the box on page 1 of this form.
3 On (fill in the date):  , I/my client filed a notice designating the record on appeal, electing 
to use a statement on appeal.
Proposed Statement
4 Reasons for Your Appeal
Remember, in an appeal, the appellate division can only review a case for whether certain kinds of legal errors 
were made (read form APP-101-INFO to learn about these legal errors):
There was not “substantial evidence” supporting the judgment, order, or other decision you are appealing.
A “prejudicial error” was made during the trial court proceedings.
The appellate division:
Cannot retry your case or take new evidence.
Cannot consider whether witnesses were telling the truth or lying.
Cannot consider whether there was more or stronger evidence supporting your position than there was 
supporting the trial court’s decision.
(Check all that apply and describe the legal error or errors you believe were made that are the reason for this 
appeal.)
a. There was not substantial evidence that supported the judgment, order, or other decision that I/my client 
indicated in the notice of appeal is being appealed in this case. (Explain why you think the judgment, order, 
or other decision was not supported by substantial evidence):
b. The following error or errors about either the law or court procedure was/were made that caused substantial 
harm to me/my client. (Describe each error and how you were/your client was harmed by that error.)
(1) Describe the error: 
Describe how you were/your client was harmed by the error:
APP-104, Page 2 of 7

Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
4 b. (2) Describe the error: 
Describe how you were/your client was harmed by the error:
(3) Describe the error: 
Describe how you were/your client was harmed by the error:
Check here if you need more space to describe these or other errors and attach a separate page or pages 
describing the errors. At the top of each page, write “APP-104, item 4.”
5 The Dispute
a. In the trial court, I/my client was the (check one):
Plaintiff (the party who filed the complaint in the case).
Defendant (the party against whom the complaint was filed).
b. The plaintiff’s complaint in this case was about (briefly describe what was claimed in the complaint filed with  
the trial court):
c. The defendant’s response to this complaint was (briefly describe how the defendant responded to the complaint 
filed with the trial court):
Check here if you need more space to describe the dispute and attach a separate page or pages describing it. 
At the top of each page, write “APP-104, Item 5.”
APP-104, Page 3 of 7

Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
6 Summary of Any Motions and the Court's Order on the Motion 
a. Were any motions (requests for the trial court to issue an order) made in this case that are relevant to the reasons 
you gave in  4   for this appeal?
Yes (fill out b) No (skip to   7  )
b. In the spaces below, describe any motions (requests for orders) that were made in the trial court that are 
relevant to the reasons you gave in  4   for this appeal. Write a complete and accurate summary of what was 
said at any hearings on these motions and indicate how the trial court ruled on these motions.
(1) Describe the first motion:
The motion was filed by the plaintiff defendant.
There     was was not a hearing on this motion.
If there was a hearing on this motion, write a complete and accurate summary of what was said at this 
hearing:
The trial court  granted this motion did not grant this motion.
Other (describe any other action the trial court took concerning this motion):
Check here if you need more space to describe this motion and attach a separate page or pages  
describing this motion. At the top of each page, write “APP-104, Item 6b(1).”
(2) Describe the second motion:
The motion was filed by the plaintiff defendant.
There     was was not a hearing on this motion.
If there was a hearing on this motion, write a complete and accurate summary of what was said at this 
hearing:
The trial court  granted this motion. did not grant this motion.
APP-104, Page 4 of 7

Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
6 b. (2) Other (describe any other action the trial court took concerning this motion):
Check here if you need more space to describe this motion and attach a separate page or pages  
describing this motion. At the top of each page, write “APP-104, item 6b(2).”
(3) Check here if any other motions were filed that are relevant to the reasons you gave in   4   for this  
appeal and attach a separate page describing each motion, identifying who made the motion and whether 
there was a hearing on the motion, summarizing what was said at the hearing on the motion, and 
indicating whether the trial court granted or denied the motion. At the top of each page, write “APP-104, 
item 6b(3).”
7 Summary of Testimony and Other Evidence
a. Was there a trial in your case?
No (skip items b, c, d, and e and go to item   8  )
Yes (check (1) or (2) and complete items b, c, d, and e)
(1) Jury trial
(2) Trial by judge only
b. Did you/your client testify at the trial?
No
Yes (Write a complete and accurate summary of the testimony you/your client gave that is relevant to the  
reasons you gave in   4   for this appeal. Include only what you actually said; do not comment or give your 
opinion about what was said. Please indicate whether any objections were made concerning your/your 
client’s testimony or any exhibits you/your client asked to present and whether these objections were 
sustained.):
Check here if you need more space to summarize your/your client’s testimony and attach a separate 
page  or pages summarizing this testimony. At the top of each page, write “APP-104, Item 7b.”
c. Were there any other witnesses at the trial whose testimony is relevant to the reasons you gave in   4  for this  
appeal?
No
Yes (complete items (1), (2), and (3)):
(1) The witness’s name is (fill in the witness’s name):
(2) The witness testified on behalf of the (check one): plaintiff defendant.
APP-104, Page 5 of 7

Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
7 c. (3) This witness testified that  (Write a complete and accurate summary of the witness’s testimony that is  
relevant to the reasons you gave in   4   for this appeal. Include only what the witness actually said; do 
not comment on or give your opinion about what the witness said. Please indicate whether any 
objections were made concerning this witness’s testimony or any exhibits this witness asked to present 
and whether these objections were sustained.):
Check here if you need more space to summarize this witness’s testimony and attach a separate page 
or pages summarizing this testimony. At the top of each page, write “APP-104, Item 7c.”
d. Check here if any other witnesses gave testimony at the trial that is relevant to the reasons you gave in   4  
for this appeal. Attach a separate page or pages identifying each witness and who the witness testified for,  
summarizing the witness’s testimony that is relevant to the reasons you gave in  4   for this appeal, and 
indicating whether any objections were made concerning this witness’s testimony or any exhibits the witness 
asked to present and whether these objections were sustained. At the top of each page, write “APP-104, Item 
7d.”
e. Summarize the evidence, other than testimony, that was given during the trial that is relevant to the reasons you  
gave in  4   for this appeal. (Write a complete and accurate summary of the evidence given by both you and the  
respondent. Include only the evidence given; do not comment on or give your opinion about this evidence.):
Check here if you need more space to describe the evidence and attach a separate page or pages describing 
the evidence. At the top of each page, write “APP-104, Item 7e.”
8 The Trial Court's Findings
Did the trial court make findings in the case?      
No
Yes (describe the findings made by the trial court):
Check here if you need more space to describe the trial court’s findings and attach a separate page or 
pages  describing these findings. At the top of each page, write “APP-104, Item 8.”
APP-104, Page 6 of 7

For your protection and privacy, please press the Clear 
This Form button after you have printed the form.
Rev. January 1, 2021 Proposed Statement on Appeal 
(Limited Civil Case)
Trial Court Case Name: 
Trial Court Case Number:
9 The Trial Court's Final Judgment
The trial court issued the following final judgment in this case (check all that apply and fill in any required 
information):
a. I/My client was required to:
pay the other party damages of (fill in the amount of the damages): $ 
do the following (describe what you were ordered to do):
b. The other party was required to:
pay me/my client damages of (fill in the amount of the damages): $
do the following (describe what the other party was ordered to do):
c. Other (describe):
Check here if you need more space to describe the trial court’s judgment or order and attach a separate 
page or pages describing this judgment or order. At the top of each page, write “APP-104, Item 9.”
Date:
Type or print your name
 Signature of appellant or attorney
APP-104, Page 7 of 7

Retrieval chunks

• #1

  Form ID: APP-104 Title: Proposed Statement on Appeal (Limited Civil Case) Effective Date: 2021-01-01 Mandatory Form: no Info Page: https://selfhelp.courts.ca.gov/jcc-form/APP-104 Primary Download URL: https://www.courts.ca.gov/documents/app104.pdf Form Detail Page: Proposed Statement on Appeal (Limited Civil Ca…

• #2

  Serve a copy of the completed form on each of the other parties and keep proof of this service. You can get information about how to serve court papers and proof of service from What Is Proof of Service? (form APP-109-INFO) and on the California Courts Online Self-Help Center at www.courts.ca.gov/selfhelp-serving.…

• #3

  a. There was not substantial evidence that supported the judgment, order, or other decision that I/my client indicated in the notice of appeal is being appealed in this case. (Explain why you think the judgment, order, or other decision was not supported by substantial evidence): b. The following error or errors ab…

• #4

  The motion was filed by the plaintiff defendant. There was was not a hearing on this motion. If there was a hearing on this motion, write a complete and accurate summary of what was said at this hearing: The trial court granted this motion did not grant this motion. Other (describe any other action the trial…

• #5

  page or pages summarizing this testimony. At the top of each page, write “APP-104, Item 7b.” c. Were there any other witnesses at the trial whose testimony is relevant to the reasons you gave in 4 for this appeal? No Yes (complete items (1), (2), and (3)): (1) The witness’s name is (fill in the witness’s name…

• #6

  Check here if you need more space to describe the trial court’s findings and attach a separate page or pages describing these findings. At the top of each page, write “APP-104, Item 8.” APP-104, Page 6 of 7 For your protection and privacy, please press the Clear This Form button after you have printed the form. …