IN THE ASHTABULA MUNICIPAL COURT SMALL CLAIMS DIVISION ASHTABULA, OHIO _________________________________________ _________________________________________ _________________________________________ Phone____________________________________ PLAINTIFF VS. _________________________________________ _________________________________________ _________________________________________ Phone____________________________________ DEFENDANT TO THE CLERK: Please take notice that a claim is hereby filed against the above defendant(s) and request that he/she/they be summoned to appear in Court to answer same. STATEMENT OF CLAIM ______ Account Exhibit A attached and made a part hereof. ______ Wages $______________ ______ Other_____________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Wherefore, Plaintiff prays judgment against defendant(s) in the sum of $_____________, plus interest from the _____ day of _________________, ______, at the rate of ________% per annum and costs. AFFIDAVIT OF COMPLAINANT'S CLAIM STATE OF OHIO ) COUNTY OF ASHTABULA ) SS: ____________________________ being first duly sworn, on oath states that __________the Plaintiff(s) in the above entitled cause, that the said cause is for the payment of money, that the nature of plaintiff's demand 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. _______________________________________ Plaintiff Subscribed and sworn to before me the ______ day of __________________, 20______. _______________________________________ Clerk, Deputy Clerk, Notary Public CASE NO. ______________________
SMALL CLAIMS COMPLAINT