Free Claim and Notice of Claim - Oregon

(THIS FORM MUST BE TYPED OR PRINTED LEGIBLY IN BLACK OR BLUE INK)

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN SMALL CLAIMS DEPARTMENT
Name ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ , Plaintiff ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ , Plaintiff Add ress _____________________________________________ _____________________________________________ Phone (_______) ____________________________________ vs. Name _____ _____ _____ _____ _____ _____ _____ _____ _____ , Defendant _____ _____ _____ _____ _____ _____ _____ _____ _____ , Defendant
If defendant is a business, serve: _______________________________________ ( __Officer __Reg. Agent __Owner)

CASE NO : _______________________________

CLAIM AND NOTICE OF CLAIM

Add ress _____________________________________________ _____________________________________________ Phone (_______) ____________________________________

I, Plaintiff, claim that on or about ___ ___ ___ ___ ___ ___ ___ ___ ___ , the above name d D efendant of ____ ___ ___ ___ ___ ___ __ C ounty, Oregon, owed me the sum of $___________________ and this sum is still owing for: ______________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ STATE OF OREGON ) _________________ COUNTY ) ss. I, the above named Plaintiff, having been duly sworn, state that I have read the above claim and that it is true as I verily believe. I state that I have made a Bona Fide effort to collect this claim before filing with the Court. Signed: __________________________________________________________ Subscribed and sworn before me this __________ day of ______________________________________, 20_______. ______________________________________________________ NOTARY PUBLIC/COURT CLERK My Commission Expires: ____________________________ _______________________________________________________________________________________________________________________ NOTICE TO DEFENDANT: I certify that the foregoing is a true copy of a claim filed against you. TRIAL COURT ADMINISTRATOR BY: _________________________________________ ATTENTION DEFENDANT: YOU MUST READ NOTICE OF THE REVERSE SIDE. COSTS PAID: SMALL CLAIMS FEE: $____________ SERVICE FEE: $____________ Rev 6/06

NOTICE TO DEFENDANT: READ THESE PAPERS CAREFULLY
Within 14 days after receiving this notice, you MUST do one of the following: Please complete the Defendant's Answer Form and file it with the Court. 1. 2. 3. 4. Pay the claim, including Plaintiff's filing fees, services fee and any accruing costs. Deny the claim and demand a hearing. You must pay the appropriate fee to the court. Deny the claim, demand a hearing and file a counterclaim. The counterclaim must pertain to the same matter as Plaintiff's claim. You must pay the appropriate fee to the Court. Demand a jury trial. You may choose this only if the claim exceeds $750. You must pay the appropriate fee to the Court.

If you fail to do one of the above things within 14 days after receiving this notice, then upon written request from the Plaintiff, the Clerk of the Court will enter a judgment against you for the amount claimed plus fees and service expenses paid by the Plaintiff, plus a prevailing party fee. If you have any questions about this notice, you may contact the Court. THE COURT CLERK CANNOT GIVE LEGAL ADVICE. FOR LAWYER REFERRAL, CALL THE OREGON STATE BAR LAWYER REFERRAL SERVICE AT 1-800-452-7636.

ALL DOCUMENTS MUST INCLUDE YOUR SIGNATURE, ADDRESS AND TELEPHONE NUMBER AND MUST BE FILED WITH: LINN COUNTY CIRCUIT COURT P O BOX 1749 300 SW FOURTH ST ALBANY OR 97321 (541) 967-3845