MAGISTRATE COURT OF COUNTY, GEORGIA Date Filed Case No: STATEMENT OF CLAIM Plaintiff(s) Name, Address vs Defendant(s) Name, Address ANSWER / COUNTERCLAIM OF DEFENDANT(S) [ ] [ ] [ ] I admit the claims of the Plaintiff.I request a payment schedule.I deny the claim of Plaintiff(s) as follows: (Attach additional sheets as needed.) 4. I counterclaim against the Plaintiff(s) as follows: ( You must i nclude a brief statement giving reasonable notice of the basi s for each claim contained in the counterclaim. Attach additional sheets as needed.) being first duly sworn on oath says the facts set forth in the foregoing Answer (and/or Countercla im) are true and correct. Sworn to and subscribed before me this day of , 20 . [ ] Defendant Deputy Clerk / Notary Public American LegalNet, Inc. www.FormsWorkFlow.com MAGISTRATE COURT OF COUNTY, GEORGIA Date Filed Case No: STATEMENT OF CLAIM ANSWER / COUNTERCLAIM OF DEFENDANT(S) American LegalNet, Inc. www.FormsWorkFlow.com MAGISTRATE COURT OF COUNTY, GEORGIA Date Filed Case No: STATEMENT OF CLAIM ANSWER / COUNTERCLAIM OF DEFENDANT(S) American LegalNet, Inc. www.FormsWorkFlow.com