VERMILION MUNICIPAL COURT _________________________________ YOUR NAME _________________________________ ADDRESS _________________________________ CITY, STATE, ZIP PLAINTIFF VS. _________________________________ THEIR NAME _________________________________ ADDRESS _________________________________ CITY, STATE, ZIP DEFENDANT CASE NO._________________ COMPLAINT FOR EVICTION AND MONEY IN ACCORDANCE WITH CIVIL RULE 4.6 (C)OR (D) AND (E), ORDINARY MAIL WAIVER REQUESTED FIRST CLAIM 1. Plaintiff states that they are the owner of the premises. The address that the tenant is to be evicted from is: _____________________________________ __________________________________________________________________________ 2. Defendant(s) entered said premises as a tenant of the plaintiff. 3. Plaintiff served the defendant with a notice in writing on: ______________ __________________________________________________________________________ 4. The date on the notice when the tenants were told to leave was: __________ __________________________________________________________________________ SECOND CLAIM 1. Plaintiff reiterates and reaffirms all of the allegations in the first claim. The tenant(s) owe rent in the amount of $_________________________which Includes all rent up to and including the current rental period. 2. Plaintiff is entitled to $________________ per day (divide 1 month’s rent by 30 to get amount) as damages for use and occupancy of the premises until the date of judgment, this being the reasonable value for the use of said premises. 3. Plaintiff may be entitled to money for damages beyond “normal wear and tear”, in addition to late charges and utilities, in amount not to exceed $__________________________ (you must make an estimate on this amount). WHEREFORE, PLAINTIFF DEMANDS: (a) Restitution and recovery of said premises. (b) Judgment for back rent in the amount of $____________________ (See line 1 on second claim). (c) $________________ per day until date of judgment for use and occupancy of said premises (See line 2 on second claim). (d) Damages, late charges, & utilities not to exceed $___________________ (See line 2 on third claim), and costs. ___________________________________ SIGNATURE ___________________________________ ADDRESS ___________________________________ CITY, STATE, ZIP ___________________________________ TELEPHONE American LegalNet, Inc. www.FormsWorkflow.com