Small Claims Affidavit
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1NO. _________________________
PETITIONER:
IN THE DISTRICT COURT
JUDICIAL DISTRICT
DEFENDANT:
{COUNTY, STATE}
CLAIM AFFIDAVIT
Petitioner Full Name:
Mailing Address:
Phone Number:
Occupation:
Defendant Full Name:
Mailing Address:
Phone Number:
Occupation:
Petitioner claims the following from the Defendant:
Statement
Reason for the Claim
Amount Claimed:
Court Fees:
Total Amount:
PETITIONER SIGNATURE
Subscribed and sworn to before me this
day of
20
(Notary Public),
County.
20
My commission expires
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