MAGISTRATE COURT OF COBB COUNTY STATE OF GEORGIA Public Safety Building 32 Waddell Street Marietta, Georgia 30090-9656 (770) 528-8910 Internet address:w ww.cobbmagistratecourt.org Civil Action No. ___________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _______________________________________Plaintiff (Name and Address) Defendant (Name and Address)___________________________________ _______________________________________Phone Number Phone Number Statement of Claim (___________) Suit on a Note (___________) Suit on Account (__________) OtherPlaintiff states Defendant is indebted to Plaintiff as follows: That said claim is in the amount of $______________ (principal owed) plus $ ______________Court costs to date; and all future costs of this suit. State of Georgia, Cobb County _________________________________ being duly sworn on oath, states the foregoing is a just and true statement of the claimmade by Plaintiff against Defendant. Sworn to and subscribed before me this _______________________________________This ______ day of __________, 20____. (Agent for) Plaintiff____________________________________ _______________________________________Notary Public or Attesting Offi cial (If Agent, Title/Capacity) Notice and Summons To _________________________________ You are hereby notified that __________________________ has made and filed a claim and is asking for judgment against youin the sum of $______________________ as shown by the foregoing statement. YOU ARE REQUIRED TO FILE ORPRESENT AN ANSWER TO THIS CLAIM WITHIN 30 DAYS AFTER SERVICE OF THIS CLAIM UPON YOU. IF YOUDO NOT ANSWER, JUDGMENT BY DEFAULT WILL BE ENTERED AGAINST YOU. Your answer may be filed in writing(notarized) or given orally under oath in the presence of the Chief or Presiding Magistrate or to the Clerk durin gwo rergkuinlagrhours. ______________________________________ Deputy Clerk, Magistrate Court of Cobb County