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Small Claims Court Forms








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Small Claims Court Form Template

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Statement of Claim


State of: _______________________

County of: ______________________

CASE No. ______________________


Plaintiff Name: _________________________________

VS.

Defendant Name: _______________________________


Plaintiff’s Home Address: _______________________________________________

Plaintiff’s Attorney’s Address: ____________________________________________


Defendant’s Home Address: _____________________________________________

Defendant’s Attorney’s Address: __________________________________________


NOTICE TO THE DEFENDANT

YOU ARE BEING SUED IN THE SMALL CLAIMS COURT BY THE ABOVE LISTED PLAINTIFF(S). THE JUDGE HAS NOT YET MADE A DECISION IN THE ABOVE LISTED CASE, YOU HAVE A RIGHT TO A TRIAL TO TELL YOUR SIDE OF THE CASE. HOWEVER, IF YOU, OR YOUR LAWYER, FAIL TO FILL OUT THE ENCLOSED ANSWER FORM AND DELIVER OR MAIL IT OT THE CLERK OF THE COURT AT THE ADDRESS LISTED BELOW, A JUDGMENT CAN BE TAKEN AGAINST YOU FOR THE MONEY OR PROPERTY DEMANDED IN THE FOLLOWING COMPLAINT, ONCE A JUDGMENT HAS BEEN ENTERED AGAINST YOU, YOUR PAYCHECK CAN BE GARNISHED AND/OR YOUR HOME PROPERTY SOLD TO PAYOFF THE JUDGMENT.

1. I hereby claim the defendant owes the plaintiff the sum of $ ______________________

For the following reason: ___________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2. The plaintiff also claims from the defendant court costs in the sum of $______________

Plus $_______________ for interest and $______________ for lawyers’ fees (only if plaintiff is represented by a licensed, practicing

attorney and if the contract or note you signed so provides.)

NOTE: The total amount of court costs may be more than this amount when the case is finally settled.

The clerk of the court will inform you of any additional costs at the close of the above listed case.

Clerk’s Address: ______________________________________________________


_______________________________________________________________________
Plaintiff or Plaintiff’s Attorney Signature

Attorney Code: _____________________

Plaintiff’s or Plaintiffs Attorney’s Phone Number: ____________________

Date of Filing: ____/____/______











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