Form Aoc-175-Small Claims Complaint Page 2
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2AOC 175
Doc. Code: COM
Plaintiff’s Name ____________________________________________
Rev. 5-11
Page 2 of 2
CLAIM
1. Plaintiff claims Defendant:
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NOTE TO PLAINTIFF: Only the Complaint will be served on the Defendant. Attachments WILL NOT be served.
2. Plaintiff claims the sum of $ _______________________ from the defendant for damages incurred as a result of the
above complaint. (The jurisdictional authority of Small Claims Court is $2,500.00, exclusive of interest and
costs. KRS 24A.230).
3. Plaintiff also claims the following court costs: _____________________________________________________.
Court costs will be added to any judgment rendered in favor of plaintiff.
Date: ___________________________, 2______.
_______________________________________________
Plaintiff’s or Attorney’s Signature
SMALL CLAIMS AFFIDAVIT
KRS 24A.250(1) reads as follows: No party shall file more than twenty-five (25) claims in any one (1) calendar year
in the Small Claims Division of any District Court in the Commonwealth. Any business engaged in trade or commerce
shall be entitled to the maximum number of claims allowed under this section of each established location in the district
that has been engaged in trade or commerce for at least six (6) months. KRS 24A.250(4) exempts claims brought by
city, county or urban-county governments from the limit on the number of claims that may be filed in a calendar year.
I swear (or affirm) I have not brought more than the maximum number of claims allowed by KRS 24A.250.
Date: ____________________________, 2_______.
___________________________________________
Affiant's Signature
Subscribed and sworn to before me by ________________________________________________ this ____________
day of _____________________________, 2_______. My Commission expires: ____________________, 2_______.
Signature: ______________________________________________
Title:
______________________________________________
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