Small Claims Petition Form

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SMALL CLAIMS PETITION
_____________________________________________
Name
Circleville Municipal Court
_____________________________________________
151 East Franklin Street
Address
Post Office Box 128
_____________________________________________
Circleville, Ohio 43113
Phone Number
Plaintiff,
-v-
Case No. __________________________
_____________________________________________
Name
_____________________________________________
Address
_____________________________________________
Phone Number
Defendant.
TO THE CLERK:
Please take notice that a claim is hereby filed against the above defendant(s) and request that she/he/they be summoned to appear in
Court the answer same.
STATEMENT OF CLAIM
‫ٱ‬
‫ٱ‬
ACCOUNT – EXHIBIT A ATTACHED AND MADE A PART HEREOF
WAGES ________________________________________
‫ٱ‬
OTHER __________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
__________________________________________________________________________________________
Wherefore plaintiff prays judgment against defendant in the sum of $__________, plus interest from the _____ day of
________________, 20___, at the rate of _____% and costs.
AFFIDAVIT OF COMPLAINANT’S CLAIM
STATE OF OHIO
)
COUNTY OF PICKAWAY
)
ss.
______________________________, being duly sworn, on oath states that she/he, is Plaintiff in the above entitled cause; that the said cause if
for the payment of money that the nature of Plaintiff’s demands is as stated, and that there is due to Plaintiff from the Defendant the amount
stated above; Defendant(s) is/are not now in the military or naval service of the United States.
____________________________________________________
Subscribed and sworn to before me this _____ day of ________________, 20___.
NOTICE AND SUMMONS IN ACTIONS FOR MONEY ONLY
TO:
(1) _____________________________________
(2) _____________________________________
Defendant
Defendant
_____________________________________
_____________________________________
Street and Number
Street and Number
_____________________________________
_____________________________________
City
State Zip
City
State Zip
______________________________ ask(s) judgment in this court against you for ________________________________________ dollars
($__________), plus interest from the _____ day of ________________, 20___, at the rate of _____% and costs, upon the following claim:
__________________________________________________.
The Court will hold trial on this claim in the Small Claims Division located at Circleville Municipal Court, 151 East Franklin Street,
Circleville, Ohio, at ________ o’clock __.m. on ________________, the _____ day of ________________, 20___,
in Courtroom
#1.
If you do not appear at the trial, judgment may be entered against you by default, and your earnings may be subjected to garnishment
or your property may be attached to satisfy said judgment. If your defense is supported by witnesses, account books, receipts, or other
documents, you must produce them at the trial. Subpoenas for witnesses, if requested by a party, will be issued by the clerk.
If you admit the claim but desire time to pay, you may make such a request at the trial.
_____________________________________________
Clerk – Deputy Clerk, Small Claims Division

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