IN THE DISTRICT COURT OF WHATCOM COUNTY, WASHINGTON 311 Grand Avenue Bellingham, WA 98225-4081 Phone: (360) 676-6770 PLAINTIFF'S NAME SMALL CLAIM # ADDRESS CITY STATE ZIP NOTICE OF SMALL CLAIM HOME PHONE NO WORK PHONE NO. VS. DEFENDANT'S NAME DEFENDANT'S NAME ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE NO. 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 the Whatcom County District Court, 311 Grand Avenue, Suite 401, Bellingham, Washington on __________________ at 9:00 a.m. for trial. You must be ready 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. Please bring two copies of any documents or photographs you want the judge to consider as evidence. 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. Date Issued _______________________________ Notice of Small Claim - Page 1 of 2 Ver. 1/18/12 Clerk American LegalNet, Inc. www.FormsWorkFlow.com STATEMENT OF CLAIM I, , the undersigned plaintiff, declare that the Defendant(s) named above owes me the sum of $ , which became due and owing on the date of ___________________________ . The amount owed is for: Faulty Workmanship Wages Other Explain reason for claim: Loan Merchandise Return of Deposit Auto Damages-Date of Accident Rent Property Damage I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at _______________________, [City] _________ [State] on_________________ [Date]. Signature Print or Type Name Notice of Small Claim - Page 2 of 2 Ver. 1/18/12 American LegalNet, Inc. www.FormsWorkFlow.com