IN THE DISTRICT COURT OF SPOKANE COUNTY WASHINGTON NOTICE OF SMALL CLAIM SMALL CLAIM # __________________________ AMENDED NOTICE OF SMALL CLAIMS PLAINTIFF'S NAME ADDRESS CITY HOME PHONE NO STATE WORK PHONE NO ZIP PLAINTIFF'S NAME ADDRESS CITY HOME PHONE NO STATE ZIP WORK PHONE NO VS. DEFENDANT'S NAME ADDRESS CITY HOME PHONE NO STATE ZIP DEFENDANT'S NAME ADDRESS CITY HOME PHONE NO STATE ZIP WORK PHONE NO WORK PHONE NO YOU ARE HEREBY NOTIFIED that the above named Plaintiff has filed a claim against you amounting to $ ; the reasons for which are stated below. YOU ARE HEREBY FURTHER NOTIFIED to be and appear at Spokane County District Court at the Broadway Center Building, 721 N. Jefferson, Spokane, Washington on _______________________ [Date], at ______________ a.m../p.m. for trial. Valley Court Office, 12710 E. Sprague, Spokane Valley, WA 99216 on _______________________ [Date], at ______________ a.m../p.m. for trial. You are to bring with you any and all papers, contracts and proof needed by you to establish or defend this claim. At the time of trial you must bring any witnesses who will testify on your behalf. YOU ARE FURTHER NOTIFIED that if you fail to personally appear as directed, a Judgment may be entered against you for the amount claimed, plus Plaintiff's costs of filing and service of the claim upon you. Plaintiff must also appear if a Judgment is to be entered. If Plaintiff fails to appear, the claim may be dismissed. If this claim is settled prior to the hearing date, the parties must notify the Court immediately, in writing. Clerk Notice of Small Claim Page 1 of 2 RCW 12.40.020, .050. .060, .070 Original ­ Court Copy ­ Plaintiff(s) Copy ­ Defendant(s) District Court complies with Americans with Disability Act requirements ­ for accommodations contact Court Operations Manager 477-2903 American LegalNet, Inc. www.FormsWorkFlow.com Small Claim # STATEMENT OF CLAIM I, , the undersigned plaintiff, declare that the defendant named above owes me the sum of $ , which became due and owing on [Date]. Plaintiff has demanded payment and Defendant refuses to pay. The amount owed is for: Faulty Workmanship Loan Merchandise Auto Damages-Date of Accident Return of Deposit Rent Property Damage Wages Other ______________________________________________________________________________________ Explain reason for claim _________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _________________________________________________________________________ I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at Spokane, Washington on ____________________ [Date]. Signature Print or Type Name Notice of Small Claim Page 2 of 2 RCW 12.40.020, .050. .060, .070 Original ­ Court Copy ­ Plaintiff(s) Copy ­ Defendant(s) District Court complies with Americans with Disability Act requirements ­ for accommodations contact Court Operations Manager 477-2903 American LegalNet, Inc. www.FormsWorkFlow.com