FORM IO2B Small Claim Complaint and Docket IN THE CIRCUIT COURT OF THE Court Copy-White Defendant's Copy-Pink Plaintiff's Copy-Canary Copy-Green Byers Printing Company, Springfield, I1Iinois. JUDICIAL CIRCUIT .cOUNTY, ILLINOIS Complaint VS Case Number Plaintiff() s Defendant(s) SMALL CLAIM COMPLAINT I, the undersigned, claim that the defendant is indebted to the plaintiff in the sum of $ for 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. Date (Month Day Year) (Signature of Plaintiff) : in the State of Illinois. AFFIDAVIT on oath states that the allegations in this complaint are true. (SEAL) Signed and sworn to before me (Notary Public) SMALL CLAIM DOCKET Complaint filed on Date Reset Date Reset FEES CLERK'S Certified Mail Sheriff Execution by by by Plaintiffin Court Clerk Clerk Clerk Defendant- in Court Judgment for $ Stay Against Costs $ days Dismissed as to (Judgeor Magistrate) (Additional Space for cow! notation on back) American LegalNet, Inc. www.FormsWorkflow.com COURT'S NOTATIONS Vol. Page Date American LegalNet, Inc. www.FormsWorkflow.com