LAKEWOOD MUNICIPAL COURT 12650 Detroit Avenue Lakewood, Ohio 44107 216.529.6700 SMALL CLAIM COMPLAINT Case No. __________________ Plaintiff ________________________________________ (Print Name) Defendant _________________________________________ (Print Name) Address ________________________________________ (Number and Street) Address ________________________________________ (Number and Street) ________________________________________ (City, State, Zip) ________________________________________ (City, State, Zip) Phone Plaintiff ________________________________________ ________________________________________ (Print Name) Phone ________________________________________ Defendant ________________________________________ (Print Name) Address ________________________________________ (Number and Street) Address ________________________________________ (Number and Street) ________________________________________ (City, State, Zip) ________________________________________ (City, State Zip) Phone ____________________________________ Phone ____________________________________ STATEMENT OF CLAIM ACCOUNT ­ EXHIBIT ATTACHED AND MADE A PART HEREOF __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Wherefore plaintiff prays judgment against defendant in the sum of $__________________, plus interest from the date of judgment and costs. STATE OF OHIO COUNTY OF CUYAHOGA } } AFFIDAVIT OF COMPLAINT'S CLAIM _____________________________________, being first duly sworn, on oath states that they are the Plaintiff(s) in the above entitled cause; that the said cause is for the payment of money that the nature of plaintiff's demand is as stated, and that there is due to plaintiff from the defendant the amount stated above; defendant(s) (is/are) not now in the military or naval service of the United States. Plaintiff _________________________________________ Subscribed and sworn to before me this ___________ day of ___________________________, 20 _________. _______________________________________ Clerk, Deputy Clerk, Notary Public American LegalNet, Inc. www.FormsWorkFlow.com