IN THE DELAWARE MUNICIPAL COURT, DELAWARE COUNTY, OHIO 70 North Union Street, Delaware, Ohio 43015 ! Voice: 740.203.1560 ! Facsimile: 740.203.1599 ! www.municipalcourt.org * Name of Plaintiff(s) * Street Address * City, State Zip Plaintiff(s) Instructions: Please, type or print all information. If additional space is required, additional sheets may be attached. Provide a brief description of the basis for the complaint in the space provided and attach any documents upon which the complaint is based. Complaints that are incomplete, unfounded, or lack required attachments are subject to dismissal. Other proper forms are accepted. This form is not legal advice; for advice you must confer with an attorney. CASE NO: CVI vs. * Name of Defendant (1) Name of Defendant (2) Street Address City, State Zip * Street Address * City, State Zip Telephone No. / email Defendant Telephone No. / email Defendant Small Claims Complaint and Request for Service per R.C. �� 1925.04-05. Plaintiff(s) demand(s) judgment against Defendant(s) in the amount of $* or $3,000 (the maximum demand permitted in Small Claims Court), whichever is less, plus court costs and interest. The undersigned plaintiff(s), or attorney therefore, swear(s), or affirm(s), that upon careful investigation, defendant(s) is(are) not now on active duty in the United States armed service. Further, Defendant(s) owe(s) the sum demanded for the reason(s) below shown. * Serve process by (*check one) [ ]certified mail, if unclaimed or refused, then by ordinary mail. [ ] [ ]The attached contract(s), promissory note(s), other document(s), and/or further narrative, is/are part of this complaint. . *X Signature of Plaintiff / Attorney for Plaintiff Print name of attorney for Plaintiff (if filed by attorney.) SCR# * Plaintiff/Attorney phone number Attorney Address (if filed by attorney) * Plaintiff/Attorney email / facsimile number Attorney City, State Zip (if filed by attorney) *Line/area must be completed. Subscribed and sworn/affirmed before me on the date shown WebCV S Claim Complaint 032013 FITB.cmp.wpd 0312131250 �2010, 2013 K. Pelanda Ver 12Mar13 Cindy Dinovo, Clerk / Deputy Clerk / Notary Public Date Small Claims Complaint American LegalNet, Inc. www.FormsWorkFlow.com