MAGISTRATE COURT OF LEE COUNTY STATE OF GEORGIA Case No.____________________ PLAINTIFF: DEFENDANT: Phone: Phone: STATEMENT OF CLAIM Suit on Account. Other Explain____________________________ Suit on a note. Plaintiff says the defendant is indebted to the plaintiff as follows: cost to date; and all future cost of this suit. That said claim is in the amount of $ plus $ STATE OF GEORGIA, LEE COUNTY: being duly sworn on oath, says the forgoing is a just and true statement of the plaintiff and claim made by plaintiff against defendant, exclusive of all set-offs and just grounds of defense. (Agent for) Plaintiff this day of , 19/20 (Notary Public or Attesting Official) (If agent, title/capacity) NOTICE AND SUMMONS To: You are hereby notified that has made a claim and is requesting judgement against you in the sum of dollars, 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, JUDGEMENT BY DEFAULT WILL BE ENTERED AGAINST YOU. Your answer may be filed in writing or may be given orally to a magistrate or clerk during regular court hours. The court will hold a hearing upon this claim at a time to be set after your answer is filed. If you have witnesses, books, receipts, or other writings bearing on this claim, you should bring them with you at the time of the hearing. If you wish to have witnesses summonsed, see the court at once for assistance. If you have any claim against the plaintiff, you should notify the Court at the time you file your answer. Clerk, Magistrate Court of Lee County American LegalNet, Inc. www.FormsWorkFlow.com