MAGISTRATE COURT OF COUNTY, GEORGIA DATE FILED CASE NO. vs. DISMISSAL OF CLAIM The Plaintiff(s) in the above styled action does ( do) hereby voluntarily dismiss the claim against the Defendant(s) [ ] with prejudice (case may not be re - filed). [ ] without prejudice (case may be re - filed within statute of li mitations). This day of , 20. Plaintiff(s) DISMISSAL OF COUNTERCLAIM The Defendant(s) in the above styled action does ( do) hereby voluntarily dism iss the claim against the Plaintiff(s) [ ] with prejudice (case may not be re - filed). [ ] without prejudice (case may be re-filed within statute of limitations This day of , 20. Defendant(s) CERTIFICATE OF SERVICE I hereby certify that I have served a copy of this Dismissal upon the other party in the following manner: [ ] by hand delivering a copy to the other party; [ ] by mailin g a copy by first class mail to the address listed below: This day of , 20 . [ ] Plaintiff(s) [ ] Defendant(s) American LegalNet, Inc. www.FormsWorkFlow.com