IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT OGLE COUNTY, ILLINOIS _________________________________________ Plaintiff(s), vs. Defendant(s) ) ) ) ) ) ) ) ) ) Case No. SMALL CLAIMS COMPLAINT I, the undersigned, claim that the defendant is indebted to the plaintiff in the sum of $__________________for And that plaintiff had 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 That the plaintiff resides at in the State of Illinois. AFFIDAVIT _________________________________________ on oath states that the allegations in this complaint are true. Signature of Plaintiff Signed and sworn to before me ,20 Notary Public Name: Attorney for: Address: City/State/Zip: Phone: occ24 American LegalNet, Inc. www.FormsWorkFlow.com