File No. STATE OF NORTH CAROLINA COMPLAINT FOR MONEY OWED G.S. 7A-216, 7A-232 County 1. The defendant is a resident of the county named above. 2. The defendant owes me the amount listed for the following reason: In The General Court Of Justice District Court Division-Small Claims Name And Address Of Plaintiff Principal Amount Owed Interest Owed (if any) Total Amount Owed (check one below) $ $ $ County Telephone No. On An Account (attach a copy of the account) Corporation Date From Which Interest Due Beginning Date Ending Date Interest Rate Interest Rate Interest Rate Interest Rate Name And Address Of Defendant 1 VERSUS Individual For Goods Sold And Delivered Between For Money Lent On a Promissory Note (attach copy) (attach a copy of the check) Date From Which Interest Due Date Of Note Date From Which Interest Due County Name And Address Of Defendant 2 Telephone No. Individual Corporation For a Worthless Check For conversion (describe property) Other: (specify) County Telephone No. Name And Address Of Plaintiff's Attorney I demand to recover the total amount listed above, plus interest and reimbursement for court costs. Date Name Of Plaintiff Or Attorney (Type Or Print) Signature Of Plaintiff Or Attorney (Over) AOC-CVM-200, Rev. 9/13 © 2013 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS TO PLAINTIFF OR DEFENDANT 1. The PLAINTIFF must file a small claim action in the county where at least one of the defendants resides. 2. The PLAINTIFF cannot sue in small claims court for more than $10,000.00. This amount may be lower, depending on local judicial order. If the amount is lower, it may be any amount between $5,000.00 and $10,000.00, as determined by the chief district court judge of the judicial district. 3. The PLAINTIFF must show the complete name and address of the defendant to ensure service on the defendant. If there are two defendants and they reside at different addresses, the plaintiff must include both addresses. The plaintiff must determine if the defendant is a corporation and sue in the complete corporate name. If the business is not a corporation, the plaintiff must determine the owner's name and sue the owner. 4. The PLAINTIFF may serve the defendant(s) by mailing a copy of the summons and complaint by registered or certified mail, return receipt requested, addressed to the party to be served or by paying the costs to have the sheriff serve the summons and complaint. If certified or registered mail is used, the plaintiff must prepare and file a sworn statement with the Clerk of Superior Court proving service by certified mail and must attach to that statement the postal receipt showing that the letter was accepted. 5. The PLAINTIFF must pay advance court costs at the time of filing this Complaint. In the event that judgment is entered in favor of the plaintiff, court costs may be charged against the defendant. 6. The DEFENDANT may file a written answer, making defense to the claim, in the office of the Clerk of Superior Court. This answer should be accompanied by a copy for the plaintiff and be filed no later than the time set for trial. The filing of the answer DOES NOT relieve the defendant of the need to appear before the magistrate to assert the defendant's defense. 7. Whether or not an answer is filed, the PLAINTIFF must appear before the magistrate. 8. The PLAINTIFF or the DEFENDANT may appeal the magistrate's decision in this case. To appeal, notice must be given in open court when the judgment is rendered, or notice may be given in writing to the Clerk of Superior Court within ten (10) days after the judgment is rendered. If notice is given in writing, the appealing party must also serve written notice of appeal on all other parties. The appealing party must PAY to the Clerk of Superior Court the costs of court for appeal within twenty (20) days after the judgment is rendered. 9. This form is supplied in order to expedite the handling of small claims. It is designed to cover the most common claims. 10. The Clerk or magistrate cannot advise you about your case or assist you in completing this form. If you have any questions, you should consult an attorney. AOC-CVM-200, Rev. 9/13 © 2013 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com