Form CA 101-A: Unsworn Declaration Supplement

Form CA 101-A: Unsworn Declaration Supplement is designed to replace sworn written declarations, verifications, certificates, statements, oaths, or affidavits unless otherwise specified by law. It is particularly noted that this form cannot be used to supplement a verified complaint in the Landlord and Tenant Branch or Small Claims Branch. This form is attached to any document requiring a sworn declaration to verify the truthfulness of the content. It provides two distinct sections for declarations made inside and outside the United States.

Executed Inside the United States

• A statement declaring under penalty of perjury that the information is true and correct.
• Requires the date of execution, printed name, signature, city and state or other location, and phone number.
• Reference: D.C. Code § 22-2402 (a)(3) (2010).

Executed Outside the United States

• A statement declaring under penalty of perjury under the law of the District of Columbia that the information is true and correct and that the declarant is physically located outside the United States and its territories.
• Requires the date of execution, city or other location, country, printed name, signature, and phone number.
• Reference: D.C. Code § 16-5306 (2010).

Fill in the appropriate information based on whether the declaration is being made inside or outside the United States. And then attach this form to the relevant document.

Steps to Fill Out the Form

1. Header Section
   • Plaintiff(s): Enter the name(s) of the plaintiff(s) involved in the case.
   • Defendant(s): Enter the name(s) of the defendant(s) involved in the case.
   • Case Number: Enter the official case number associated with the legal proceedings.

2. Document Supplementation
   • Identify the document this form is supplementing. Write the title of the pleading, motion, or other documents in the space provided after “This form supplements”.
3. Declaration Sections
   • Choose the appropriate section based on whether you are inside or outside the United States when making the declaration.

4. If Executed Inside the United States
   • Declaration Statement: Read the statement declaring the truthfulness of the information under penalty of perjury.
   • Execution Date: Fill in the day, month, and year when you are signing the declaration.
   • Printed Name: Print your full name clearly.
   • Signature: Sign your name.
   • City and State or Other Location: Enter the city and state where you are signing the document.
   • Phone Number: Provide your phone number for contact purposes.

5. If Executed Outside the United States
   • Declaration Statement: Read the statement declaring the truthfulness of the information under penalty of perjury and confirming that you are outside the geographic boundaries of the United States and its territories.
   • Execution Date: Fill in the day, month, and year when you are signing the declaration.
   • City or Other Location and Country: Enter the city or other location and country where you are signing the document.
   • Printed Name: Print your full name clearly.
   • Signature: Sign your name.
   • Phone Number: Provide your phone number for contact purposes.

Important Notes

• Ensure all information is accurate and complete.
• Sign the form in the appropriate section based on your location.
• Attach this form to the document it is supplementing.
• Refer to D.C. Code §§ 22-2402 (a)(3) and 16-5306 (2010) for legal references and further details.

By following these steps, you will ensure that the Unsworn Declaration Supplement is correctly filled out and legally valid.