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Claim And Notice Of Claim Form. This is a Oregon form and can be use in Uniform Trial Court Statewide.
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Tags: Claim And Notice Of Claim, 15.010.1a, Oregon Statewide, Uniform Trial Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR
COUNTY
Small Claims Division - _____________________________________________________
(court’s address and phone number)
Plaintiff
Address
City
State
Zip
County
v.
Defendant
Defendant
A.K.A.
A.K.A.
)
)
)
)
)
)
)
)
)
)
)
CASE No.
CLAIM AND
NOTICE OF CLAIM
Name, Title (if applicable) and Address for Service on Defendant(s):
Defendant
Defendant
A.K.A.
A.K.A.
Address
Address
City
State
Zip
City
County
State
Zip
County
I, Plaintiff, claim that on or about _____________,______, the above-named defendant(s) owed me the
sum of $____________, and this sum is still owing for (reason) _______________________________
__________________________________________________________________________________
__________________________________________________________________________________
I have incurred fees of $__________ and service expense of $__________.
Claim Amt: ________
Filing Fee: ________
Service Fee: ________
I have made a bona fide effort to collect the claim from the defendant before filing the claim with the
clerk.
I hereby declare that the above statement is true to the best of my knowledge and belief, and that I
understand it is made for use as evidence in court and is subject to penalty for perjury.
DATED: ____________________
_________________________________________
Plaintiff
********************************************************************************************************************
NOTICE TO DEFENDANT: I certify that the foregoing is a true copy of the claim filed against you.
TRIAL COURT ADMINISTRATOR
By_______________________________________
NOTICE TO DEFENDANT — READ REVERSE SIDE
Page 1 – Form 15.010.1a – CLAIM AND NOTICE OF CLAIM – UTCR 15.010(1)(a)
(Revised 8-1-10)
UTCR App. Page 55
American LegalNet, Inc.
www.FormsWorkFlow.com
NOTICE TO DEFENDANT
READ THESE PAPERS CAREFULLY!
Within 14 DAYS after receiving this notice you MUST do ONE of the following things:
Pay the claim plus filing and service expenses paid by the plaintiff; OR
Demand a hearing; OR
Demand a jury trial.
If you fail to do one of the following things within 14 DAYS after receiving this notice, then upon written
request from the plaintiff, the clerk of the court will enter a judgment against you for the amount claimed
plus filing fees and service expenses paid by the plaintiff, plus a prevailing party fee.
If you have any questions about the small claims court filing procedures after this notice, you may
contact the clerk of the court; however, the clerk cannot give you legal advice on this claim.
Defendant filing fees (to be filled in by plaintiff with fees for specific county where filed):
To Demand a Hearing if the amount claimed is $1500.00 or less ...........
$
To Demand a Hearing if the amount claimed is over $1500.00 ............... $
To Demand a Jury Trial (Only if the amount claimed is over $750.00) .... $
Page 2 – Form 15.010.1a – CLAIM AND NOTICE OF CLAIM – UTCR 15.010(1)(a)
(Revised 8-1-10)
UTCR App. Page 56
American LegalNet, Inc.
www.FormsWorkFlow.com
