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APP-104Optional

Proposed Statement on Appeal (Limited Civil Case)

California · Judicial Council of California · Effective January 1, 2021

This form asks the person appealing a case to write a draft summary of what happened during the trial court's spoken proceedings. It is used to explain the reasons for the appeal to the appellate division.

The court describes it as: 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.

Open the official PDFfrom Judicial Council of California

Where this fits in a case

Appeal

Stage: Appeal

This form is used by a person who is appealing a judgment or order from a limited civil case in the trial court. It must be used if the person is preparing a proposed statement on appeal and is not represented by a lawyer for the appeal.

Usually filed by the person starting the case.

Official instructions

How-to guides published by the court for this form.

Common questions

Who must fill out this form?
This form must be used by the appellant, which is the party filing the appeal. You must use it if you are not represented by an attorney for the appeal.
When must this form be filed?
If it is not attached to the Notice Designating Record on Appeal, this form must be filed no later than 20 days after you file that notice.
What should I do after filling it out?
You must make a copy for your records and for every other party. You must also serve a copy on every other party and keep proof of that service.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect January 1, 2021.

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