IN THE MAGISTRATE COURT OF LIBERTY COUNTY STATE OF GEORGIA Post Office Box 50 Hinesville, Georgia 31310-0050 Plaintiff(s) Phone No. Address v. Case Number Phone No. Defendant(s) Address STATEMENT OF CLAIM The above-named Defendant/Defendants is/aresubject to the jurisdiction of this court. The Defendant/Defendants is/are indebted to the Plaintiff/Plaintiffs in the amount of $ . The Plaintiffs/Plaintiffs claim against the Defendant/Defendants is based upon the following: Wherefore, Plaintiff/Plaintiffs demand/demands judgment against the Defendant/Defendants for the sum of $ , plus costs. VERIFICATION GEORGIA, LIBERTY COUNTY Plaintiff(s) Name(s), being first duly sworn under oath, says that the foregoing is a just and true statement of the amount owing by Defendant to Plaintiff, exclusive of all setoffs and just grounds of defense. Sworn to and subscribed before me on this day of , 2003. Notary Public (or Attesting Official) Plaintiff (s) (or Agent NOTICE AND SUMMONS To: Defendant For assistance of further information, Home Address call (912) 876-3625. or Business Address 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 above, as shown by the foregoing statement. The court will hold a hearing upon this claim in the Magistrate Courtroom, in the Liberty County Courthouse Annex, Main Street, Hinesville, Georgia at a time to be set after your answer is filed. You are required to file or present to the Clerk of this court an answer to this claim within thirty (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 and in person to the judge or clerk. You are required to be present at the hearing in order to avoid a judgment by default against you. 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 summoned, notify the Clerk or Clerks staff at once. If you admit to the claim, but desire additional time to pay, you must still answer this claim and come to the hearing in person and state circumstances to the court. You may come with or without an attorney. _________________________________ Clerk/Deputy Clerk of Magistrate Court