IN THE MAGISTRATE COURT OF COUNTY, WEST VIRGINIA Name, Address & Phone Number of Plaintiff: Case No. v. Name, Address & Phone Number of Defendant --- fold here --- --- fold here --- CIVIL COMPLAINT The above-named plaintiff or of , on behalf of the plaintiff acting in the capacity , alleges the following as true and accurate [give a clear and simple statement of the claim against the defendant(s)]: and requests the following relief from the court: Signature Date NOTICE: Any party in a civil action seeking over $20.00 or possession of real estate has the right to elect that the case be tried by a jury. You must give written notice to the magistrate court either 20 days from whcn the first timely answer to the complaint is made or 5 days from when service of the summons and complaint is made for unlawful entry and detainer actions. If you do not notify the magistrate court within the appropriate time period, you give up your right to a jury trial. The jury fee will be assessed against the losing party if the case is tried by a jury or may be prorated between the parties if the case is settled before trial. (OPTIONAL) NOTICE OF ELECTION: As plaintiff in the above action, I wish to have a jury trial. Signature Date NOTICE: Any person involved in court proceedings who has a disability and needs special accommodations should inform the court sufficiently in advance so that arrangements can be made if possible. W.Va. Code §§ 50-4-1, 50-5-8(a); Mag. Ct. Civ. Rules 2, 6A SCA-M207 / 10-94 Return Defendant File Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com