Free Claim of Appeal from a Small Claims Judgment - Massachusetts

COMMONWEALTH OF MASSACHUSETTS
________________,SS: HOUSING COURT DEPARTMENT _______________ DIVISION / / / - / / / / / / SMALL CLAIMS NO.

CLAIM OF APPEAL FROM A SMALL CLAIMS JUDGMENT
Plaintiff's Name, Address and Zip Code

_____________________________________ _____________________________________ _____________________________________ Defendant's Name, Address and Zip Code ______________________________________ ______________________________________ ______________________________________ _________________________________ Telephone _________________________________ Telephone

I hereby claim a trial of this small claims before a Housing Court jury, pursuant to General Laws chapter 218, §23 and Chapter 185C, §3. I received the

court's "Notice of Judgment" in this case on _______________________, 20____. I state on oath that this claim of jury trial is intended in good faith, and there are questions of fact and law requiring a jury trial, specifically: _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
This is signed under the penalties of perjury: ______________________________________ _____________________________________________________________________________________ Date: Defendant's Signature: