COUNTY STATE OF WISCONSIN, CIRCUIT COURT, DANE For Official Use Plaintiff: (Name [first, middle, last], Address, City, State, Zip) -vs- Amended See attached for additional plaintiffs Summons and Complaint Small Claims To: Defendant(s) : (Name [first, middle, last], Address, City, State, Zip) Case No. See attached for additional defendants If you require reasonable accommodations due to a disability to participate in the court process, please call 266-4311 (TDD 266-4625) and ask for the Court ADA Coordinator at least 10 working days prior to the scheduled court date. Please note that the court does not provide transportation. Claim for money ($10,000 or less) Return of property (replevin) Eviction Eviction due to foreclosure Arbitration award Return of earnest money Tort/Personal injury ($5,000 or less) 31001 31003 31004 31002 31006 31008 31010 SUMMONS To the Defendant(s): You are being sued as described below. If you wish to dispute this matter: You must appear at the time and place stated. OR You must file a written answer and provide a copy to the plaintiff or plaintiff’s attorney on or before the date and time stated. When to Appear/File an Answer Time Date Place to Appear/File an Answer If you do not appear or answer, the plaintiff may win this case and a judgment entered for what the plaintiff is asking. Dane County Courthouse 215 South Hamilton Street Madison, Wisconsin 53703-3285 Clerk of Circuit Court Office, Room 1000 Commissioner Center, Room 2000 Information number: (608) 266-4311 Clerk/Attorney Signature Date Summons Issued Date Summons Mailed COMPLAINT Plaintiff's Demand: The plaintiff states the following claim against the defendant(s): 1. Plaintiff demands judgment for: (Check as appropriate) Claim for Money $ Eviction Return of Earnest Money Return of property (replevin) (Describe property in 2 below.) Tort/Personal injury $ Eviction due to foreclosure Confirmation, vacation, modification or (Not to include Wis. Stats. 425.205 actions to recover collateral.) correction of arbitration award. Plus interest, costs, attorney fees, if any, and such other relief as the court deems proper. 2. Brief statement of dates and facts: (If this is an eviction action and you are seeking money damages, you must also state that claim on this form.) For eviction actions in Dane County, money damages are not to be stated on this form. Please see reverse side for instructions. See attached for additional information. Provide copy of attachments for court and defendant(s). Verification: Under oath, I state that the above complaint is true, except as those matters stated upon information and attorney for the plaintiff. plaintiff. belief, and as to those matters, I believe them to be true. I am: State of County of Subscribed and sworn to before me on Signature of Plaintiff or Attorney Date Attorney’s State Bar Number Plaintiff'’s/Attorney's Telephone Number Law Firm and Address Notary Public/Court Official Name Printed or Typed My commission/term expires: An original and sufficient copies for service purposes of this document must be submitted at the time of filing (one for each defendant if mail services allowed by court, two for each defendant if personal service is required. SC-500, 08/11 Summons and Compliant – Small Claims Chapter 799, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 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