Fillable Debt Claim Petition Form printable pdf download

CAUSE NO.________________

(court use only)

_________________________________________________

IN THE JUSTICE COURT

_________________________________________________

Plaintiff(s)

VS.

OF CHAMBERS COUNTY, TEXAS

_________________________________________________

Defendant(s)

PRECINCT ______

DEBT CLAIM PETITION

COMPLAINT: The basis for the claim which entitles the plaintiff to seek relief against the defendant is:

________________________________________________________________________________________________________________________

RELIEF: Plaintiff seeks damages in the amount of $_______________.

SERVICE OF CITATION: Service is requested on defendants by personal service at home or work or by alternate service as allowed by the Rules of

Practice in Justice Courts. Other addresses where the defendant(s) may be served are:

_______________________________________________________________________________________________________________________.

ADDITIONAL INFORMATION (CASE BASED ON CREDIT CARD, REVOLVING ACCOUNT, OR OPENT ACCOUNT):

Account/Credit Card Name:____________________________________ Account Number (may be masked):____________________________.

Date of Issue/Origination:_____________ Date of Charge-Off/Breach:_______________ Amount Owed $______________ as of ____________

ADDITIONAL INFORMATION (CASE BASED ON PROMISSORY NOTE OR OTHER PROMISE TO PAY PERSONAL OR BUSINESS

LOAN):

Account/Credit Card Name:____________________________________ Account Number (may be masked):____________________________.

Date of Issue/Origination:_____________ Date of Charge-Off/Breach:_______________ Amount Owed $______________ as of ____________

ONGOING INTEREST: Plaintiff

does, or

does not seek ongoing interest. If so, this interest is based on the following contractual or

statutory reason:___________________________________________ and should be at ________%. $_____________ of interest was due as of

________________________, 20____.

ASSIGNMENT OF CLAIM: Plaintiff

was or

was not assigned or otherwise transferred this claim. If so, the original claimant or creditor

was:_______________________________________, subsequent holders were _____________________________________ and the date the case was

assigned/transferred to plaintiff was ____________________________________, 20____.

If you wish to give your consent for the answer and any other motions or pleadings to be sent to your email address, please

check this box, and provide your valid email address:__________________________________________________________.

DEFENDANT(S) INFORMATION (if known):

________________________________________________

Signature of Plaintiff or Attorney

__________________________________________________

Address of Defendant(s)

__________________________________________________

Petitioner’s Printed Name

__________________________________________________

City

State

Zip

__________________________________________________

Address of Plaintiff’s Attorney, if any, or Plaintiff if none

DATE OF BIRTH:__________________________________

__________________________________________________

*LAST 3 NUMBERS OF DRIVERS LICENSE:___________

City

State

Zip

*LAST 3 NUMBERS OF SOCIAL SECURITY:___________

___________________________________________________

Phone & Fax No. of Plaintiff’s Attorney, if any, or Plaintiff if none

DEFENDANT’S PHONE NO._________________________

Debt Claim Petition Form

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