IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT, STEPHENSON COUNTY, ILLINOIS Case Number Plaintiff (s) VS File Stamp Defendant(s). SMALL CLAIM COMPLAINT I, the undersigned, claim that the defendant(s) is 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 no part thereof has been paid; that the defendant(s) reside(s) at Phone No. that the plaintiff resides at Phone No. Date (Month Day Year) (Signature of Plaintiff(s) : in the State of Illinois. AFFIDAVIT on oath states that the allegations in this complaint are true. (NOTARY SEAL) Signed and sworn to before me , (Notary Public) Original filed with Circuit Clerk Office (Need to provide copy for Defendant and Plaintiff) American LegalNet, Inc. www.USCourtForms.com