Small Claims - State Of Wisconsin Circuit Court Milwaukee County Page 2
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2☐ APPLIANCE Describe Damage:
Year appl. installed:
Cost of original appliance:
Current Repair Cost:
A copy of the receipt from the original purchase is attached
☐Yes ☐No
Photographs of the damage are available ☐Yes ☐No
☐ OTHER:
a.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
b.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
c.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
d.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
e.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
f.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
g.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
h.
Describe Damage:
Repair Cost:
I have attached a copy of the receipt or invoice.
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
i.
Additional Damages (Describe):
Repair Cost:
I have attached a copy of the receipt(s) or invoice(s).
Photographs of the damage are available ☐Yes ☐No Photographs are attached ☐Yes ☐No
☐
Plaintiff is seeking RENT DOUBLE damages in the total amount of: $
, which are calculated as follows:
The Notice to Vacate was served on
, and Defendant(s) was expected to surrender the property on
. There was a Stipulation between Plaintiff and Defendant(s) that began on
and ended on
, which allowed Defendant(s) to remain in possession of the unit with the consent of
Plaintiff so long as Defendant(s) surrendered the unit on or before the last day of the Stipulation. The Defendant (did) (did not)
comply with the Stipulation. The Defendant surrendered the property on
.
Period/Month of:
Base Rent $:
Per Day $:
Days:
Total:
Period/Month of:
Base Rent $:
Per Day $:
Days:
Total:
Period/Month of:
Base Rent $:
Per Day $:
Days:
Total:
Total amount of damages calculated above: $
.
The defendant is entitled to a security deposit credit of $
.
Total amount of damages sought: $
.
Date:
Print Name:
☐Plaintiff ☐Authorized Agent for Plaintiff ☐Attorney for Plaintiff
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