STATEMENT OF SMALL CLAIM AND NOTICE Trial Court of Massachusetts Small Claims Session COURT DIVISION WHERE THE PLAINTIFF IS FILING THIS CLAIM PLAINTIFF INFORMATION: The person filing the claim is the plaintiff.Pltf. Name:Address:City/State/Zip:Phone No.: PLAINTIFF'S ATTORNEY (if any)Atty. Name:Address:City/State/Zip:Phone No.:BBO NO: Def. #1 Name:Address:City/State/Zip:Phone No.: Def. #2 Name:Address:City/State/Zip:Phone No.: MEDIATION: Mediation of this claim may be available if both parties agree to discuss the matter with a mediator, who will assist the parties in trying to resolve the dispute on mutually agreed to terms. The plaintiff must notify the court if he or she desires mediation; the defendant may consent to mediation on the trial date. The plaintiff is willing to attempt to settle this claim through mediation: YES NO The Plaintiff claims that the Defendant(s) OWE plus court costs for the following reasons:MILITARY AFFIDAVIT: The plaintiff states under the pains and penalties of perjury that the: above defendant(s) is (are) not serving in the military and at present live(s) or works at the above address. above defendant(s) is (are) serving in the military. I am unsure if the above defendant(s) is (are) in the military.www.mass.gov/courtsEfile\SC\March 2017 Part A - ORIGINAL (For Court File)NOTICE TO PLAINTIFF: You may bring your small claim only in the court for the area where either the plaintiff or the defendant lives or has a place of business or employment. A small claim against a landlord arising from the rental of an apartment may also be brought where the apartment is located. You may find it easier to enforce a decision in your favor if you bring your small claim where the defendant lives or works, but you are not required to do so. The Clerk-Magistrate's office can tell you which court serves an area and the fee you must pay to file your claim.SIGNATURE OF PLAINTIFF: X DATE:PLAINTIFF'S CLAIM: Fill in below the amount you are suing for and briefly explain your claim. State your claim clearly so the defendant can understand why he or she is being sued. Give the date of the event that is the basis of your claim. Fill in as "costs" the amount of the filing fee. DEFENDANT(S) INFORMATION: The person or corporation being sued is the defendant. If you are suing a company which is not a corporation, you should name the owner(s) doing business as the named company as the defendant; the names of the owner(s) can be obtained from the City or Town Clerk where the company's offices are located. If you are suing a company which is a corporation, you must have the exact legal name. You can find this information from the Corporate Records Division of the Secretary of State's Office, One Ashburton Place, Room 1712, Boston, MA 02108.SIGNATURE OF PLAINTIFF: XDATE:INSTRUCTIONS TO PLAINTIFF: You must sign and date this claim and the military affidavit, and return Parts A, B and C of the completed form to the court, together with a check or money order (made payable to "Clerk-Magistrate") for the filing fee. You may bring or mail the completed form and filing fee to the Clerk-Magistrate's office of the court where you are filing your case. DOCKET NO. (For Court Use Only) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF SMALL CLAIM AND NOTICE Trial Court of Massachusetts Small Claims Session COURT DIVISION WHERE THE PLAINTIFF IS FILING THIS CLAIM PLAINTIFF INFORMATION: The person filing the claim is the plaintiff.Pltf. Name:Address:City/State/Zip:Phone No.: PLAINTIFF'S ATTORNEY (if any)Atty. Name:Address:City/State/Zip:Phone No.:BBO NO: Def. #1 Name:Address:City/State/Zip:Phone No.: Def. #2 Name:Address:City/State/Zip:Phone No.: MEDIATION: Mediation of this claim may be available if both parties agree to discuss the matter with a mediator, who will assist the parties in trying to resolve the dispute on mutually agreed to terms. The plaintiff must notify the court if he or she desires mediation; the defendant may consent to mediation on the trial date. The plaintiff is willing to attempt to settle this claim through mediation: YES NO The Plaintiff claims that the Defendant(s) OWE pluscourt costs for the following reasons:MILITARY AFFIDAVIT: The plaintiff states under the pains and penalties of perjury that the: above defendant(s) is (are) not serving in the military and at present live(s) or works at the above address. above defendant(s) is (are) serving in the military. I am unsure if the above defendant(s) is (are) in the military.www.mass.gov/courtsEfile\SC\March 2017 Part B - DEFENDANT COPY (to be sent withTrial Notice)NOTICE TO THE DEFENDANT(S) NAMED BELOW: You are being sued in Small Claims Court by the below named plaintiff. You are directed to appear for trial of this claim on the date and time that is noted on the NOTICE OF SMALL CLAIM TRIAL form that is attached to this copy of the plaintiff's claim. If you wish to settle this claim before the trial date, you should contact the plaintiff or the plaintiff's attorney.PLAINTIFF'S CLAIMDEFENDANT(S) INFORMATION: The person or corporation being sued is the defendant. DOCKET NO. (For Court Use Only) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF SMALL CLAIM AND NOTICE Trial Court of Massachusetts Small Claims Session COURT DIVISION WHERE THE PLAINTIFF IS FILING THIS CLAIM PLAINTIFF INFORMATION: The person filing the claim is the plaintiff.Pltf. Name:Address:City/State/Zip:Phone No.: PLAINTIFF'S ATTORNEY (if any)Atty. Name:Address:City/State/Zip:Phone No.:BBO NO: Def. #1 Name:Address:City/State/Zip:Phone No.: Def. #2 Name:Address:City/State/Zip:Phone No.: MEDIATION: Mediation of this claim may be available if both parties agree to discuss the matter with a mediator, who will assist the parties in trying to resolve the dispute on mutually agreed to terms. The plaintiff must notify the court if he or she desires mediation; the defendant may consent to mediation on the trial date. The plaintiff is willing to attempt to settle this claim through mediation: YES NO The Plaintiff claims that the Defendant(s) OWE pluscourt costs for the following reasons:MILITARY AFFIDAVIT: The plaintiff states under the pains and penalties of perjury that the: above defendant(s) is (are) not serving in the military and at present live(s) or works at the above address. above defendant(s) is (are) serving in the military. I am unsure if the above defendant(s) is (are) in the military.www.mass.gov/courtsEfile\SC\March 2017 Part C - PLAINTIFF COPY (to be sent with Trial Notice)NOTICE TO THE PLAINTIFF NAMED BELOW: You have sued the below named defendant(s) in Small Claims Court. You aredirected to appear for trial of this claim on the date and time that is noted on the NOTICE OF SMALL CLAIM TRIAL form that is attached to this copy of your claim. PLAINTIFF'S CLAIMDEFENDANT(S) INFORMATION: The person or corporation being sued is the defendant. DOCKET NO. (For Court Use Only) American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF SMALL CLAIM AND NOTICE Trial Court of Massachusetts Small Claims Session COURT DIVISION WHERE THE PLAINTIFF IS FILING THIS CLAIM PLAINTIFF INFORMATION: The person filing the claim is the plaintiff.Pltf. Name:Address:City/State/Zip:Phone No.: PLAINTIFF'S ATTORNEY (if any)Atty. Name:Address:City/State/Zip:Phone No.:BBO NO: Def. #1 Name:Address:City/State/Zip:Phone No.: Def. #2 Name:Address:City/State/Zip:Phone No.: MEDIATION: Mediation of this claim may be available if both parties agree to discuss the matter with a mediator, who will assist the parties in trying to resolve the dispute on mutually agreed to terms. The plaintiff must notify the court if he or she desires mediation; the defendant may consent to mediation on the trial date. The plaintiff is willing to attempt to settle this claim through mediation: YES NO The Plaintiff claims that the Defendant(s) OWE plus court costs for the following reasons:MILITARY AFFIDAVIT: The plaintiff states under the pains and penalties of perjury that the: above defendant(s) is (are) not serving in the military and at present live(s) or works at the above address. above defendant(s) is (are) serving in the military. I am unsure i