Complaint Form - The Franklin County Municipal Court Small Claims Division Page 2
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1
2EXHIBIT C
IN THE FRANKLIN COUNTY MUNICIPAL COURT
SMALL CLAIMS DIVISION
(Please Print of Type)
Case No. ________________ CV I____________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
v.
____________________________________________________
____________________________________________________
____________________________________________________
Plaintiff(s)
Defendant(s)
Name, Address, ZIP Code, Telephone number
Name, Address, ZIP Code, Telephone number
COMPLAINT
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
___________________________________________________________________________
Please use additional page if necessary.
Has this dispute been to mediation? [ ] Yes [ ] No
WHEREFORE, plaintiff demands judgment against defendant in the sum of $________________________,
plus filing fees and other court fees, and interest from the date of judgment at the current statutory rate.
STATE OF OHIO }
AFFIDAVIT OF COMPLAINANT’S CLAIM
COUNTY OF FRANKLIN}
_____________________________________________________________________________, being duly sworn, say on oath that
(s)he is the (check one) [ ] plaintiff [ ] the attorney for the plaintiff [ ] the officer or salaried employee of
the plaintiff corporation in this case. Further, this complaint is for the payment of money only. The nature
of the plaintiff’s claim is as stated above. To the best of his or her knowledge, the defendant is not now in
the military service of the United States.
Sworn and subscribed before me this
________Day of______________, _____________
Signed: __________________________________________________________
Plaintiff, Plaintiff’s attorney or Plaintiff’s officer or salaried employee
Telephone No.:__________________________________________________
_________________________________________________
[ ] Deputy Clerk [ ] Notary Public
Attorney Supreme Court Registration No.____________________
MC/SC/10-/05
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