Form 4 - Small Claims Court Of Yukon - Third Party Claim
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1SMALL CLAIMS COURT OF YUkON
THIRD PARTY CLAIM
Form No. 4
File No.
Plaintiff(s):
(Name)
1. _________________________________________________________________________________________________
2. _________________________________________________________________________________________________
Defendant(s):
(Name)
1. _________________________________________________________________________________________________
2. _________________________________________________________________________________________________
Third party:
(Name, Address, Telephone Number(s))
1. _________________________________________________________________________________________________
2. _________________________________________________________________________________________________
TO THE THIRD PARTY: ______________________________________________________________________________
(name)
The defendant in this action: __________________________________________________________________________
(name)
claim(s) from you $_______________________________ and costs (disbursements), for the reasons set out below.
IF YOU DO NOT FILE A REPLY WITHIN TWENTY (20) DAYS (if you reside in Yukon) OR THIRTY (30) DAYS
(if you reside out of Yukon) AFTER YOU HAVE RECEIVED THIS THIRD PARTY CLAIM, JUDGMENT MAY BE
ENTERED AGAINST YOU. There is a $25.00 fee to file a Reply if you disagree with the third party claim.
REASONS FOR CLAIM AND DETAILS: (Explain what happened, where and when, and the amount of money
involved. Attach any supporting documents and additional pages where necessary.)
Defendant’s address for service of further documents is:
Physical address: ___________________________________________________________________________________
Mailing address: ____________________________________________________________________________________
(optional) e-mail: ____________________________________________________________________________________
(optional) fax: _______________________________________________________________________________________
Date: ___________________________
________________________________________________________
Signature of Defendant
________________________________________________________
Print name
Whitehorse Court Registry
Dawson City Court Registry
Watson Lake Court Registry
P.O. Box 2703
P.O. Box 651
P.O. Box 192
Whitehorse, YT Y1A 2C6
Dawson City, YT Y0B 1G0
Watson Lake, YT Y0B 1C0
Ground floor, Law Courts
Fifth Avenue and Mission
820C Adela Trail
2134 Second Avenue
(Museum Building)
(Pejest Building)
Phone (867) 667-5619
Phone (867) 993-5070
Phone (867) 536-7551
Fax (867) 393-6212
Fax: (867) 993-5311
Fax (867) 536-7564
Reference: Section 29 Small Claims Court Regulations
YG(3149QE)F2 REV. 01/2012
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