MAGISTRATE COURT OF CLAYTON COUNTY STATE OF GEORGIA Plaintiff's Name Plaintiff's Mailing Address Plaintiff's City, State, Zip vs. Defendant's Name Defendant's Street Address Defendant's City, State, Zip Case No. 2016 CM STATEMENT OF CLAIM Type of Suit Suit on a Note Suit on an Account Other: The Court has jurisdiction over the defendant because: the defendant is a resident of Clayton County; or Other: Plaintiff states the defendant is indebted to the plaintiff as follows: That said claim is in the amount of to date; and all future costs of this suit. principal, interest, plus costs being duly sworn on oath, say(s) the foregoing is a just and true statement of the amount owing by defendant to plaintiff, exclusive of all set-offs and just grounds of defense. Sworn to and subscribed before me Plaintiff/ Agent/ Attorney this day of , 20 . If Agent, list Title/Capacity NOTICE OF SUMMONS To You are hereby notified that the above named Plaintiff has made a claim and is asking for judgment against you in the sum as shown by the foregoing statement. YOU ARE REQUIRED TO FILE OR PRESENT AN ANSWER TO THIS CLAIM WITHIN 30 DAYS AFTER SERVICE OF THIS CLAIM UPON YOU. IF YOU DO NOT ANSWER, JUDGMENT BY DEFAULT WILL BE ENTERED AGAINST YOU. Your answer may be filed in writing or may be given orally to the judge. The court will hold a hearing on this claim in the Clayton County Justice Center, 9151 Tara Blvd., Jonesboro, Georgia 30236-4912, to be scheduled after your answer is filed. If you wish to have witnesses summoned, see the court at once for assistance. If you have any claim against the plaintiff, you should notify the court at once. If you admit the claim, but desire additional time to pay, you must come to the hearing in person and state the circumstances to the court. You may come with or without an attorney. JACQULINE D. WILLS For additional information, visit our website at; Clerk Magistrate Court www.co.clayton.ga.us/magistrate_court/clerk_of_courts/index.htm By: If Attorney, include Bar # Deputy Court Clerk American LegalNet, Inc. www.FormsWorkFlow.com