IN THE DISTRICT COURT OF _____________________ COUNTY, WASHINGTON PLAINTIFFS NAME SMALL CLAIM # ADDRESS CITY STATE ZIP NOTICE OF SMALL CLAIM HOME PHONE NO WORK PHONE NO. VS. DEFENDANTS NAME DEFENDANTS NAME ADDRESS ADDRESS CITY STATE CITY ZIP STATE ZIP PHONE NO. PHONE NO. YOU ARE HEREBY NOTIFIED that the above named Plaintiff has iled a claimf against you amounting to $ ; the reasons for whh are ic stated below. YOU ARE HEREBY FURTHER NOTIFIED to be and appear at _________________________ County District Court ___________________________________________ [address] _____________________ [city] Washington on _______________________ [Date], at ______________ a.m../p.m. fo r PRE-TRIAL TRIAL . You are to bring with you any and all papers, contracts and proof needby youed to establish or defend this claim. At the time of trial you must bring any witnesses who will testify on your behalf. Notice of Small Claim - Page 1 of 2 MISC 05.0100 (6/2004) RCW 12.40.020, .050. .060, .070 >>>> 2 YOU ARE FURTHER NOTIFIED that if you fail to personally appear as directed, a Judgment may be entered against you for the amount claimeplus Plaid, ntiffs costs of filing ad senrvice 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, thrties me paust notify the Court immediately, in writing. Clerk 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]. The amount owed is for: Faulty Workmanship Merchandise Auto Damages-Date of Accident Wages Loan Return of Deposit Rent Property Damage 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 _______________________, [City] ____________ [State] on ____________________ [Date]. Signature Print or Type Name Notice of Small Claim - Page 2 of 2 MISC 05.0100 (6/2004) RCW 12.40.020, .050. .060, .070