COMPLAINT SMALL CLAIMS 3310 (Rev . 2/05) UNITED STATES OF AMERICA ST ATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT CASE NUMBER PLAINTIFF(S) -VS- DEFENDANT(S) File Stamp Here SMALL CLAIMS COMPLAINT I / We, the undersigned, claim the the defendant(s) is/are indebted to the plaintiff(s) in the sum of $ for and that the plaintiff(s) has/have demanded payment of said sum; that the defendant(s) refused to pay the same and that no part thereof has been paid; that the defendant(s) reside(s) at Telephone No. the plaintiff(s) reside(s) at Telephone No. in the State of Illinois. VERIFICATION I / We, the undersigned, certify under penalties as provided by law pursuant to 735 ILCS 5/1-109 and Supreme Court Rule 137 that the statements set forth in this instrument are true and c orrect. PROSE Plaintiff or Attorney for Plaintiff DuPage Attorney Number: Signature(s) of Plaintiff or Attorney for plaintiff Address: City/State/Z ip: Signature(s) of Plaintiff Telephone: CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT WHEATON, ILLINOIS 60189-0707 American LegalNet, Inc. www.USCourtForms.com