BEDFORD MUNICIPAL COURT
165 Center Road Bedford, Ohio 44146-2898 (440) 232-3420
SMALLS CLAIMS COMPLAINT Case No: Date: Municipality: 04
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Full Name Plaintiff Street Address City State Zip
Plaintiff -vs-
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Full Name Defendant Street Address City State Zip
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
Wherefore the Plaintiff prays for judgment against Defendant(s) in the sum of _____________ plus interest from ____________ (date), at a rate of ______% per annum and costs herein. STATE OF OHIO COUNTY OF CUYAHOGA ) ) SS:
AFFIDAVIT OF COMPLAINANT'S CLAIM
_______________________(Plaintiff), being first duly sworn, on oath states that he/she/they is/are the Plaintiff in the above entitled case, that the above cause is for payment of money, that the nature of the Plaintiff's demand is as stated above. Defendant(s) is/are not now in the military or naval service of the United States. _______________________________ (Plaintiff's signature) SUBSCRIBED AND SWORN to before me on ____________(date)
______________________________ Deputy Clerk