Affidavit For Immediate Possession Form - Noble Superior Court Division 2

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NOBLE SUPERIOR COURT DIVISION 2
Amount of Claim
$ __________________
SMALL CLAIMS - 3rd Floor Court House
)
($6000.00 Max. individual / $1500.00 Business
101 North Orange St., Albion, Indiana 46701
$10.00
+ $ __________________
per Addtl Defendant
$25.00
+ $ __________________
Sheriff Service
Phone: Court 260-636-2129
Clerk 260-636-2736
for
Court Costs
+ $
96.00
Total
= __________________
(Cash, Money Order or
CLAIM NUMBER ___________________________________
)
Business Checks Only
______________________________________________________________
_______________________________________________________________
Plaintiff Name
Plaintiff Name
______________________________________________________________
_______________________________________________________________
Street Address
Street Address
______________________________________________________________
______________________________________________________________
City, State, Zip
City, State, Zip
Phone _________________________________________________________
Phone _________________________________________________________
AGAINST
============
_______________________________________________________________
______________________________________________________________
Defendant Name
Defendant Name
_______________________________________________________________
______________________________________________________________
Street Address
Street Address
_______________________________________________________________
______________________________________________________________
City, State, Zip
City, State, Zip
Phone _________________________________________________________
Phone _________________________________________________________
SS# Last 4 numbers only ________ Birth date_________________________
SS# Last 4 numbers only________ Birth date_________________________
AFFIDAVIT FOR IMMEDIATE POSSESSION
He/She is the owner of real/personal property located at ____________________________________________________________
Now held by the defendant(s) and that plaintiff)s) is now entitled to retake possession.
Immediate Possession Hearing set for the _____________day of _________________________2016 at _______________________ ___M.
TO THE DEFENDANT(S): You have been sued by the Plaintiff whose name appears above. The trial date for this law suit
is on the ________________ day of ____________________________ 2016 at _______________ ____M.
STATEMENT OF SMALL CLAIM COMPLAINT
____________________________________ state(s) that (he is/she is/they are) the Plaintiff(s) in the proceeding, that the statement
of claim herein contained is true, that the Defendant(s) owe(s) the Plaintiff(s) owe(s) the amount claims and further that:
1.
Defendant(s) is (are) not now serving in the Armed Forces of the United States of America.
2.
To the best of my (our) belief and knowledge the Defendant(s) is (are) not under legal disability and has (have) sufficient
understanding to realize the nature and effect of this Notice of Small Claim.
I (we) the undersigned, claim the Defendant(s) is (are) indebted to the Plaintiff(s) in the sum of $ __________________________ for
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
If based upon written agreement or open account, a copy of same is attached and marked as “Exhibit A”.
I (we) affirm under the penalties of perjury that the above representations are true to the best of my (our) knowledge and beliefs.
Subscribed and sworn before me, Deputy Clerk or Notary Public this
________________________________________
______________day of __________________________, 2016
Plaintiff (signature)
_____________________________________________________________
Deputy Clerk/Notary Public
My Commission Expires:
Revised 7/15

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