SMALL CLAIMS PETITION Name Address Phone No.: Plaintiff, vs. Name Address Phone No.: Defendant. TO THE CLERK: Please take notice that a claim is hereby filed against the above defendant(s) and request that she/he (they) be summoned to appear in Court to answer same. STATEMENT OF CLAIM ACCOUNT ­ EXHIBIT A ATTACHED AND MADE A PART HEREOF WAGES ___________________________________ OTHER ____________________________________________________________________________________________________ Case No. _____________________ Vandalia Municipal Court Justice Center ­ 2nd Floor 245 James E. Bohanan Memorial Drive P.O. Box 429 Vandalia, Ohio 45377 Wherefore plaintiff prays judgment against defendant in the sum of $______________, plus interest from the ____________ day of ______________________, 20______, at the rate of _________% and costs. STATE OF OHIO ) COUNTY OF MONTGOMERY ) ss. AFFIDAVIT OF COMPLAINANT'S CLAIM _______________________________, being first duly sworn, on oath states that he/she, is the Plaintiff in the above entitled cause; that the said cause is for the payment of money that the nature of plaintiff's demand is as stated, and that there is due to plaintiff from the defendant the amount stated above; defendant(s) is/are not now in the military or naval service of the United States. ____________________________________________________ Subscribed and sworn to before me this ______ day ________________, 20____. ____________________________________________________ NOTICE AND SUMMONS IN ACTION FOR MONEY ONLY To: (1) Defendant Street and Number City State Zip (2) Defendant Street and Number City State Zip ____________________________________________________________ ask(s) judgment in this court against you for ________________________________________________ dollars ($__________), plus interest from the ________ day of ________________, 20______ at the rate of ______% and costs, upon the following claim: ___________________________________________________________. The Court will hold trial on this claim in the Small Claims Division located at Vandalia Municipal Court, 245 James E. Bohanan Dr., Vandalia, Ohio at ______ o'clock ____ M. on _________________, the ______ day of ________________, 20____, in Courtroom #1. If you do not appear at the trial, judgment may be entered against you by default, and your earnings may be subjected to garnishment or your property may be attached to satisfy said judgment. If your defense is supported by witnesses, account books, receipts, or other documents, you must produce them at the trial. Subpoenas for witnesses, if requested by a party, will be issued by the clerk. If you admit the claim but desire time to pay, you may make such a request at the trial. _______________________________________________ Clerk ­ Deputy Clerk, Small Claims Division American LegalNet, Inc. www.FormsWorkFlow.com