IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. Amount Claimed Plaintiff/Petitioner Defendant/Respondent File Stamp SMALL CLAIMS COMPLAINT I, the undersigned, claim that the defendant is indebted to the plaintiff in the sum of plus costs plus attorney's fees for: (The Nature of the Plaintiff's Claim, Giving Dates and other relevant information): 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. AFFIDAVIT on oath states that the allegations in this complaint are true. Subscribed and Sworn to before me on (Date) Notary Public Plaintiff Resides At: Name: Address: City, State, Zip: Phone: Signature Defendant Resides At: (Give residential address - not service instructions) Name: Address: City, State, Zip: Phone: Date: P2-SC-002 (01/08) Signature of Plaintiff: American LegalNet, Inc. www.FormsWorkflow.com