SMALL CLAIMS PRE-FILING INFORMATION This form does not constitute a completed notice of small claims filing and may not be used as such. This form is submitted to the clerk’s office for assignment of case number and court dates. This information will be used to create the Notice of Small Claim. The $29.00 fee must be paid by check or cash at time of filing. FAX (509) 477-6387 Plaintiff Name #1 Plaintiff Name #2 Address Address City State Zip City State Zip Home Phone Work Phone Home Phone Work Phone VS. Defendant Name #1 Defendant Name #2 Address Address City State Zip Home Phone Work Phone City State Zip Home Phone Work Phone The defendant owes $________ which became due on _________ (date). The amount owing is for: Wages Loan Auto Damages-Date of Accident_______ Damage Deposit Rent Property Damage Breach of Contract Goods/Services Other __________________________________________________ __________________________________________________________ For Court use only CASE #_______________ CT DATE___________ TIME__________ JUDGE_________ ROOM______ NWCM______ FULCRUM_______ DATE_____________ TIME_________ Rev 7-05 American LegalNet, Inc. www.USCourtForms.com