IN THE MAGISTRATE COURT OF GWINNETT COUNTY, STATE OF GEORGIA Clerk, Gwinnett Magistrate Court, P.O. Box 246 Lawrenceville, GA 30046-0246 (770.822.8100, Ext. Civil Division) Civil Action No. vs. Plaintiff(s) INFO & FORMS ON INTERNET www.gwinnettcourts.com Defendant(s) Telephone (Daytime number if known, otherwise, evening number) STATEMENT OF CLAIM [ ] Suit on Note [ ] Suit on Account 1. [ ] Other ________________________________________________________________________________ The Court has jurisdiction over the defendant(s) [ ] the Defendant(s) is a resident of Gwinnett County; [ ] Other (please specify) Plaintiff(s) claims the Defendant(s) is/are indebted to the Plaintiff as follows: (You must include a brief statement giving reasonable notice of the basis for each claim contained in the Statement of Claim) 2. _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ 3. That said claim is in the amount of: $ principal, $ interest, plus $ costs to date, and all future costs of this suit. State of Georgia, Gwinnett County: being duly sworn on oath, says 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 and subscribed before me this Plaintiff or Agent day of 20 (If Agent -- Title or Capacity) Day Time Phone Number Notary Public/Attesting Official I request a civil trial [ ] during normal business hours - OR - [ ] 6:30 PM, evening trials. NOTICE AND SUMMONS ALL CONFLICTS ARE SCHEDULED FOR 6:30 PM. TO: All Defendant(s) You are hereby notified that the above named Plaintiff(s) has/have made a claim and is requesting judgment against you in the sum shown by the foregoing statement. YOU ARE REQUIRED TO FILE or PRESENT AN ANSWER (answer forms can be obtained from the above listed web-site or clerk's office) 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. If you choose to file your answer orally, it MUST BE IN OPEN COURT IN PERSON and within the 30 day period. NO TELEPHONE ANSWERS ARE PERMITTED. The court will hold a hearing on this claim at the Gwinnett Justice & Administration Center, 75 Langley Dr., Lawrenceville, GA 30046, at a time to be scheduled after your answer is filed. You may come to court with or without an attorney. If you have witnesses, books, receipts, or other writings bearing on this claim, you should bring them to court at the time of your hearing. If you want witnesses or documents subpoenaed, see a staff person in the Clerk's office for assistance. If you have a claim against the Plaintiff, you should notify the court by immediately filing a written answer and counterclaim. If you admit to the Plaintiff's claim but need additional time to pay, you must come to the hearing in person and tell the court your financial circumstances. Your answer must be RECEIVED by the clerk within 30 days of the date of service. If you are uncertain whether your answer will timely arrive by mail, file your answer in person at the clerk's office during normal business hours. Filed this day of 20 Magistrate or Deputy Clerk of Court See Instructions on Reverse Side of This of this Document Q:\Magforms\MAG 10 Civil Filing\Statement Of Claims Mag.10-01 White--MAGISTRATE Yellow--DEFENDANT Pink--PLAINTIFF American LegalNet, Inc. www.FormsWorkFlow.com Aug 10