In the
CIRCUIT COURT
Of St. Louis County, Missouri
(Please Print Clearly) __________________________________________ Plaintiff(s) __________________________________________ Address __________________________________________ City/State/Zip __________________________________________ Phone No. vs. __________________________________________ Defendant(s) __________________________________________ Address __________________________________________ City/State/Zip __________________________________________ Phone No. _________________________ Date _________________________ Case Number _________________________ Division
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For File Stamp Only
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SMALL CLAIMS COURT
DISMISSAL
The (plaintiff) (defendant) dismisses the (claim) (counterclaim) against the (defendant) (plaintiff) (with) (without) prejudice at (plaintiff's) (defendant's) cost.
____________________________________ (Plaintiff) (Defendant) Signature ____________________________________
Dated
CCAC19 Rev. 05/98