STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT COUNTY OF BOONE Complaint vs. Case No. Plaintiffs SMALL CLAIM COMPLAINT I, the undersigned, claim that the defendant is indebted to the plaintiff in the sum of $ for Defendants and that the plaintiff has demanded payment of said sum; that the defendant refused to pay the same and no part thereof has been paid; that the defendant resides at Phone No. that the plaintiff resides at Phone No. ; in the State of Illinois. _________________________________ , 20__________ (Signature of Plaintiff) Name Attorney for Address City Telephone ; AFFIDAVIT on oath states that the allegations in this complaint are true. Signed and sworn to before me Notary Public , 20 ____ American LegalNet, Inc. www.USCourtForms.com