en-USCERTIFICATION WHEN COMPLAINT SIGNED BY AGENT OF PLAINTIFF en-USSTATE OF NORTH CAROLINAen-US en-US Countyen-USIn The General Court Of Justiceen-USDistrict Court Division - Small Claims en-USFile No. en-USCOMPLAINTen-USIN SUMMARY EJECTMENTen-US(Over)en-USCountyen-USName And Address Of Plaintiff en-US Individual en-US Corporation en-US Individual en-US Corporationen-USName And Address Of Defendant 1en-USTelephone No.en-USTelephone No.en-USName And Address Of Plaintiff222s Attorney Or Agenten-USAttorney Bar No.en-USCountyen-USVERSUS en-US3. þ The defendant failed to pay the rent due on the above date and the plaintiff made demand for the rent and waited the en-USþ þ The lease period ended on the above date and the defendant is holding over after the end of the lease period. þ þ The defendant breached the condition of the lease described below for which re-entry is specified. þ þ Criminal activity or other activity has occurred in violation of G.S. 42-63 as specified below. en-US1. The defendant is a resident of the county named above.en-US2. The defendant entered into possession of premises described below as a lessee of plaintiff.en-USDescription Of Premises (include location and address) 4. þ The plaintiff has demanded possession of the premises from the defendant, who has refused to surrender it, and the en-USplaintiff is entitled to immediate possession.en-US5. The defendant owes the plaintiff the following:en-USDescription Of Breach/Criminal Activity (give names, dates, places and illegal activity) en-USDate Rent Dueen-USDate Lease Endeden-USType Of Lease en-US Conventionalen-US en-US Public Housingen-US en-US Section 8 en-US Oral en-US Writtenen-USRate Of Rent (Tenant222s Share)en-USper en-US Monthen-US en-US Weeken-US$en-USI certify that I am an agent of the plaintiff and have actual knowledge of the facts alleged in this Complaint. 6. þ I demand to be put in possession of the premises and to recover the total amount listed above and daily rental until entry en-USof judgment plus interest and reimbursement for court costs. en-USDescription Of Any Property Damageen-USAmount Of Damage (if known)en-USAmount Of Rent Past Dueen-US$en-US$en-USTotal Amount Dueen-US$en-USDateen-USName Of Plaintiff/Attorney/Agent (type or print)en-USSignature Of Plaintiff/Attorney/Agent en-USAmerican LegalNet, Inc. www.FormsWorkFlow.com en-USINSTRUCTIONS TO PLAINTIFF OR DEFENDANT þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USdefendants resides. þ 2. þ The PLAINTIFF cannot sue in small claims court for more than $10,000.00 excluding en-USinterest and costs unless further restricted by court order. þ 3. þ The PLAINTIFF must show the complete name and address of the defendant to en-USensure service on the defendant. If there are two defendants and they reside at en-USdifferent addresses, the plaintiff must include both addresses. The plaintiff must en-USdetermine if the defendant is a corporation and sue in the complete corporate name. en-USIf the business is not a corporation, the plaintiff must determine the owner222s name en-USand sue the owner. þ 4. þ The PLAINTIFF may serve the defendant(s) by mailing a copy of the summons and þ þ þ þ þ þ þ þ þ þ þ þ en-USparty to be served or by paying the costs to have the sheriff serve the summons and þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USmust attach to that statement the postal receipt showing that the letter was accepted. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USvoucher, housing authority), the landlord should include in the 223Rate Of Rent224 box en-USonly that portion of the rent that the tenant pays directly to the landlord. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USchecked. (Defendant failed to pay the rent due on the above date and the plaintiff þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USthe complaint.) If the landlord is seeking to remove the tenant for failure to pay rent en-USwhen there is a written lease with an automatic forfeiture clause, the third block en-USshould be checked. (The defendant breached the condition of the lease described þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USthe space for description of the breach. If the landlord is seeking to evict tenant for en-USviolating some other condition in the lease, the third block should also be checked. en-US en-USIf the landlord is claiming that the term of the lease has ended and the tenant en-USrefuses to leave, the second block should be checked. If the landlord is claiming that en-UScriminal activity occurred, the fourth block should be checked and the conduct must en-USbe described in space provided. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USIn the event that judgment is rendered in favor of the plaintiff, court costs may be en-UScharged against the defendant. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USDOES NOT relieve the defendant of the need to appear before the magistrate to en-USassert the defendant222s defense. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USagree otherwise. þ 11. þ The magistrate will render judgment on the date of hearing unless the parties agree þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 12. þ The PLAINTIFF or the DEFENDANT may appeal the magistrate222s decision in this en-UScase. To appeal, notice must be given in open court when the judgment is entered, or en-USnotice may be given in writing to the Clerk of Superior Court within ten (10) days after en-USthe judgment is entered. If notice is given in writing, the appealing party must also en-USserve written notice of appeal on all other parties. The appealing party must PAY to en-USthe Clerk of Superior Court the costs of court for appeal within ten (10) days after the en-USjudgment is entered. If the appealing party applies to appeal as an indigent, and that þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USthe appeal. þ 13. þ If the defendant appeals and wishes to remain on the premises the defendant must en-USalso post a stay of execution bond within ten (10) days after the judgment is entered. In þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USpossession, the landlord shall release any personal property of the tenant. If, after en-USbeing placed in lawful possession by execution of a writ, the landlord has offered to en-USrelease the tenant222s property and the tenant fails to retrieve such property during the en-USlandlord222s regular business hours within seven (7) days after execution of the writ, en-USthe landlord may throw away, dispose of, or sell the property in accordance with the en-USprovisions of G.S. 42-25.9(g). If sold, the landlord must disburse any surplus proceeds þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USproperty to the tenant, in which case the landlord shall release possession of the en-USproperty to the tenant during regular business hours or at a time agreed upon. þ 15. þ This form is supplied in order to expedite the handling of small claims. It is designed en-USto cover the most common claims.en-USTHE CLERK OR MAGISTRATE CANNOT ADVISE YOU ABOUT YOUR CASE OR ASSIST YOU IN COMPLETING THIS FORM.en-US en-USIF YOU HAVE ANY QUESTIONS, YOU SHOULD CONSULT AN ATTORNEY. American LegalNet, Inc. www.FormsWorkFlow.com