PRINT in BLACK ink Enter the name of the county in which you are filing this case. Enter the Plaintiff's name and address. STATE OF WISCONSIN, CIRCUIT COURT, DANE Plaintiff(s) (Name and Address): First name Middle name Last name For Official Use COUNTY If there is more than one plaintiff, check the "additional plaintiffs" box and attach another sheet with their names and addresses. __________________ Enter the case number. Address Address Small Claims Publication Summons And Notice State Zip City See attached for additional plaintiffs. -vsDefendant(s) (Name and Address): Case No. If you need help in this matter because of a disability, please call: Enter the Defendant's name and address. First name Middle name Last name 266-4311 (WI Relay 7-1-1) and ask for the Court ADA Coordinator Address If there is more than one defendant, check the "additional defendants" box and attach another sheet with their names and addresses. Address City State Zip See attached for additional defendants. Publication Summons and Notice of Filing TO THE PERSON(S) NAMED ABOVE AS DEFENDANT(S): You are being sued by the person(s) named above as Plaintiff(s). A copy of the claim has been sent to you at your address as stated in the caption above. The lawsuit will be heard in the following Small Claims court: Dane County Courthouse Telephone Number of Clerk of Court: (608) 266-4311 Courtroom/Room Number: 1000 Address: 215 South Hamilton Street Address: City: Madison State WI Zip 53703-3285 on the following date and time: Date: Time: a.m. / p.m. If you do not attend the hearing, the court may enter a judgment against you in favor of the person(s) suing you. A copy of the claim has been sent to you at your address as stated in the caption above. A judgment may be enforced as provided by law. A judgment awarding money may become a lien against any real estate you own now or in the future, and may also be enforced by garnishment or seizure of property. You may have the option to Answer without appearing in court on the court date by filing a written Answer with the clerk of court before the court date. You must send a copy of your Answer to the Plaintiff(s) named above at their address. You may contact the clerk of court at the telephone number above to determine if there are other methods to answer a Small Claims complaint in that county. Signature of Plaintiff/Attorney Plaintiff's/Attorney's Telephone Number Date Attorney's State Bar Number Law Firm and Address Enter the county in which you are filing this case. Get the date, time, location of the hearing, and telephone number from the Clerk of Court. Enter the information at right. A copy of the publication notice and a copy of the original summons and complaint must be mailed to the defendant at the last known address. Sign here. Enter your phone number and date. Leave the Attorney's State Bar Number box blank. Notice to Printers: Do not print the instructional text in the boxes along the left-hand column when publishing this summons. Print bolded text in bold typeface. SC-5160V, 04/08 Publication Summons and Notice ­ Small Claims Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com §§799.12(2), 799.12(4), 799.12(6), 799.16, Ch. 985, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.