APPLICATION TO FILE SMALL CLAIM/COMMERCIAL CLAIM (see reverse for jurisdictional and instructional information or visit the Ithaca City Court website at www.courts.state.ny.us/Ithaca/city) Small claims court is every Thursday morning at 9:30am. ITHACA CITY COURT : COUNTY OF TOMPKINS Ithaca City Court, 118 East Clinton Street, Ithaca, New York 14850; 607-273-2263; fax 607-277-3702 FILING FEE: Money Order, Certified Bank Check or Cash only (No Personal or Business Checks accepted) Type of Claim: Filing Fee: (Check one) Small Claim $15.00-Claim of $1,000 or less ______ $20.00-Claim exceeding $1,000 ______ (Individual suing individual or company) Commercial Claim $25.00 + $6.03 postage ______ (a separate $5.98 postage fee is required for each defendant named) (Company suing company or individual-see reverse for limitation on number of filings and required Certificate of Authority) Consumer Transaction $25.00 + $6.03 postage ______ (a separate $5.98 postage fee is required by each defendant named) (Company suing individual-see reverse for definition of Consumer Transaction, limitation on number of filings, Certificate of Authority and Demand Letter Certification) Counterclaim (see reverse) $ 5.00 + $ .44 postage Date: _____________________________________ Name(s) of Claimant(s)(list all necessary parties)____________________________________________________________________________________ __________________________________________________________________________________________ Address (if commercial claim, give Principal Office Address) Telephone no:______________________________________________________________________________ Name of Defendant (list all necessary parties)_____________________________________________________ __________________________________________________________________________________________ Address (Home or Bus/Place of Employment must be in Tompkins County) (Telephone no.) Amount of Claim $_______________________________ (Do not include filing fee) Nature of Claim to include all pertinent information including descriptions, dates, address, etc. (See reverse side for jurisdiction information). __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ DATE: SIGNATURE OF PERSON FILING CLAIM American LegalNet, Inc. www.FormsWorkFlow.com