STATE OF SOUTH CAROLINA ) _______________ COUNTY OF LEXINGTON ) IL CASE # CIV ) ___________________________________ ) PLAINTIFF ) ___________________________________ ) STREET ADDRESS ) ___________________________________ ) CITY STATE ZIP CODE ) ____________________ ) TELEPHO NE ) COMPLAINT VS ) ) ___________________________________ ) DEFEN DANT ) ___________________________________ ) STREET ADDRESS ) ___________________________________ ) CITY STATE ZIP CODE ) ____________________ ) TELEPHONE ) I, _________________________________________________________, the plaintiff in this civil action do make the following claims: 1. I believe that the defendant, ______________ ____________________________, is a resident of ______________________ County, and resides at _______________________________________________________ ______________________, which is within Judge ______________________________s magisterial jurisdiction. 2. I make this complaint on the following: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ (Attach supplement if necessary) 3. I believe, because of the above information, that I am entitled to and do request a judgement for $________________________________and / or other relief as below requested: ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ including any costs resulting in this action. I state under penalty of perjury that the above is correct and truthful. Dated:_________________________ ______________________________________________ Signature of Plaintiff (or his attorney)