Small Claims Court _________________________ County, Colorado Court Address: PLAINTIFF(S): ______________________________________________ Address: ____________________________________________________ City/State/Zip: ________________________________________________ Phone: Home _______________________ Work ___________________ v. COURT USE ONLY Case Number: DEFENDANT(S): _____________________________________________ Address: ____________________________________________________ City/State/Zip: ________________________________________________ Division Courtroom Phone: Home _______________________ Work ___________________ REQUEST TO SET ASIDE ! DISMISSAL ! DEFAULT JUDGMENT UNDER PENALTIES OF PERJURY, I DECLARE THAT THESE STATEMENTS ARE TRUE AND CORRECT. 1. I/We____________________________, am the ! Plaintiff(s) ! Defendant(s) in above captioned case. 2. My claim against the Defendant(s) was/were dismissed on (date) _____________________________. 3. OR The Plaintiff(s) Judgment was/were entered against me on (date) _____________________________. I/We did not appear in Court on the ! date of the trial or the ! date of the entry of judgment because: _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. I/We believe I/We can provide the following facts to prove my/our case or to establish my/our defense: _______________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Dated: _________________________________ ______________________________________ Signature ______________________________________ Signature ORDER The Court upon review of Request to Set Aside ! Dismissal ! Default Judgment, ORDERS the following: ! Request DENIED ! Request GRANTED ! Request to be heard by the Court on (date) __________________________. If after the request is heard and the Court finds that the request for dismissal/default judgment should be set aside, the Court ! will proceed immediately to trial at the conclusion of the hearing. ! will re-schedule the trial for another date. THE PARTIES ARE ADVISED TO BRING WITH THEM ON THE SAID DATE ALL OF THE EVIDENCE AND WITNESSES NECESSARY FOR THE COURT TRIAL. Dated: _________________________________ ___________________________________________ ! Judge ! Magistrate CERTIFICATE OF MAILING I hereby certify that on (date)__________________________, I mailed a true and correct copy of the REQUEST TO SET ASIDE DISMISSAL/DEFAULT JUDGMENT, by placing it in the United States Mail, postage pre-paid to the parties at the addresses listed above. Dated: _________________________________ JDF 253 9/01 ___________________________________________ Clerk of the Court/Deputy Clerk REQUEST TO SET ASIDE DISMISSAL/ DEFAULT JUDGMENT American LegalNet, Inc. www.FormsWorkflow.com