MAGISTRATE COURT OF ______________COUNTY, GEORGIA Date Filed ________________ Case No: _______________ STATEMENT OF CLAIM Plaintiff(s) Name, Address vs Defendant(s) Name, Address [ ] Suit on Note [ ] Suit on Account [ ] Other _________________________________________________________________________________________________________ 1. The Court has jurisdiction over the defendant(s) [ ] the Defendant(s) is a resident of ___________County; [ ] Other (please specify) 2. Plaintiff(s) claims the Defendant(s) is indebted to the Plaintiff(s) as follows (You must include a brief statement giving reasonable notice of the basis for each claim contained in the Statement of Claim): 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, _____________ County: ________________________________________________________ being duly sworn on oath says the foregoing is a just and true statement the amount owing by defendant(s) to plaintiff(s), exclusive of all set-offs and just grounds of defense. Sworn and subscribed before me this ________ day of _______________________________ 20______ Plaintiff(s) or Agent (If Agent, Title or Capacity) Notary Public/Attesting Official Day Time Phone Number NOTICE AND SUMMONS 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 at (https://georgiamagistratecouncil.com/forms) or from 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 OR CLERK. 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 ______________________________________________________, 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(s), 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. This ____________ day of ________________________, 20 ___ ___________________________________________________ Magistrate or Deputy Clerk of Court MAG 10-01 STATEMENT OF CLAIMR American LegalNet, Inc. www.FormsWorkFlow.com