STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT COUNTY OF MCLEAN STATE OF ILLINOIS ) ) SS. COUNTY OF McLEAN ) File Stamp ,) ) ) ,) ) Plaintiff, v. Defendant. Case No. Amount claimed $ SMALL CLAIM COMPLAINT PLAINTIFF 1. DEFENDANT indebted to Plaintiff for $ claims: is for: 2. 3. No part of the indebtedness has been paid. DEFENDANT resides at County, Illinois, telephone No. . 4. PLAINTIFF resides at County, Illinois, telephone No. . 5. The undersigned, being first duly sworn on oath, deposes and says that he has read the complaint and has knowledge of the contents thereof, and that the matters set out herein are true in substance and fact. Signed and sworn to before me PLAINTIFF 20 Notary Public By Circuit Clerk Deputy If PLAINTIFF is represented by counsel, Please complete the following: Counsel’s Name: Address: City: Telephone: American LegalNet, Inc. www.FormsWorkFlow.com