Form 1 - Small Claims Court Of Yukon - Claim
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1SMALL CLAIMS COURT OF YUKON
Form No. 1
CLAIM
File No. _____________
Plaintiff(s):
(Name, Telephone Number(s))
1. ________________________________________________________________________________________
2. ________________________________________________________________________________________
Defendant(s):
(Name, Address, Telephone Number(s))
1. ________________________________________________________________________________________
2. ________________________________________________________________________________________
TO THE DEFENDANT(S):
The plaintiff(s) claim(s) from you $ ____________________________ and costs 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 CLAIM, JUDGMENT MAY BE ENTERED
AGAINST YOU. There is a $25.00 fee to file a Reply if you disagree with the claim.
TYPE OF CLAIM (check one box):
N.S.F. Cheque
Damage to Property
Motor Vehicle Accident
Services Rendered
Unpaid Account
Other (describe): __________________________________________
Loan/Promissory Note
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.)
Plaintiff’s address for service of further documents is:
Physical address: ___________________________________________________________________________
Mailing address: ____________________________________________________________________________
(optional) e-mail: ____________________________________________________________________________
(optional) fax: ____________________________________________________________________________
Date: ________________________________
__________________________________________________
Signature of Plaintiff
Dawson City Court Registry
Watson Lake Court Registry
Whitehorse Court Registry
P.O. Box 651
P.O. Box 192
P.O Box 2703
Dawson City, YT Y0B 1G0
Watson Lake, YT Y0B 1C0
Whitehorse, YT Y1A 2C6
Fifth Avenue and Mission
820C Adela Trail
Ground floor, Law Courts
(Museum Building)
(Pejest Building)
2134 Second Avenue
Phone (867) 993-5070
Phone (867) 536-7551
Phone (867) 667-5619
Fax: (867) 993-5311
Fax (867) 536-7564
Fax (867) 393-6212
Reference: Sections 2 and 17 Small Claims Court Regulations
YG(3134QE)F1 Rev. 12/2015
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