Clevelan d Heights Municipal Court SMA LL CLA IM COMPLA INT 40 Se verance C ircle Cleveland Heights, OH 44118 Case No: CVI__________ _________ Plaintiff Defendant Address Address City/State/Zip City/State/Zip Plaintiff Defendant Address Address City/State/Zip City/State/Zip Telephone #: ( ) Telephone #: ( ) Is DEFENDAN T presently in the military or naval servi ce of the United Stat es? Yes No STA TEMENT OF CLA IM: W herefore Plaintiff(s) prays judgm ent against defenda nt(s) in the sum of $ plus interestfrom the day of , 20 , at the rate of % and costs.STA TE O F O HIO ) AFFIDAVIT OF COMPLAINANTS CLAIM CUYA HOGA C OU NTY ) (Printed Name) , being duly sworn on oath states that they arethe Plaintiff(s) in the above st ated cause; that said cause is for the payment of MON EY; and, that the Plaintiff(s) demand is as stat ed, and there is due to the Plaintiff(s) from the Defendant(s) the amount stat ed above. Defendant( s) is/are not now in the military or navel service of the United Stat es. Signature of Plaintiff Sw orn and subs cribed to before me this day of , 20 Clerk, Deputy Clerk or Notary Public American LegalNet, Inc. www.USCourtForms.com>>>> 2American LegalNet, Inc.www.USCourtForms.com