BOWLING GREEN MUNICIPAL COURT R.C. 1925 122001 Please PRINT SMALL CLAIMS QUESTIONNAIRE Hon. Mark B. Reddin, Judge PLAINTIFF (Person filing complaint) Name: _____________________________________ ______________________________________ Individual Partnership Corporation Individual Partnership Corporation Address: _____________________________________ ______________________________________ _____________________________________ ______________________________________ Tel. (Hm) ____________________ (Wk)____________________ If more Plaintiffs on back X here: DEFENDANT (Person being sued) Name: _____________________________________ ______________________________________ Individual Partnership Corporation Individual Partnership Corporation Address: _____________________________________ ______________________________________ _____________________________________ ______________________________________ Tel. (Hm) ____________________ (Wk)___________________ If more Defendants on back X here: Military Status. Is the defendant in the military? Claim. Place where it occurred (X one): city Yes No I don’t know. village township of ________________________, ______________________ County, Ohio. Facts. A brief statement of the claim (where, when, what, who & how much): Statement continues on back. Total amount claimed: $_________________. I waive any amount over the small claims limit of $3,000.00. DO YOU UNDERSTAND THAT: (1) If you are awarded a judgment and defendant fails to pay it, you will have to take further action to collect it? (2) Your filing fee will not be returned to you until the losing party pays the costs (R.C. 1901.26(F))? Yes No I understand that I am required to appear to present my case on the assigned court date. If I fail to appear, I understand that the case will be dismissed and my deposit will be applied to the costs. Yes No In the event that the certified mail is “unclaimed” or “refused,” please reissue by ordinary mail with certificate of mailing. Date _____/_____/_____ __________________________________________ Your signature (title with company) American LegalNet, Inc. www.USCourtForms.com American LegalNet, Inc. www.USCourtForms.com