SMALL CLAIMS COURT COMPLAINT

IN THE SMALL CLAIMS COURT OF [COUNTY/CITY] COUNTY

[STATE] STATE

Case No.: ___________________ (to be assigned by court clerk)

PLAINTIFF INFORMATION

Plaintiff Name: [PLAINTIFF FULL LEGAL NAME]
Address: [STREET ADDRESS]
[CITY], [STATE] [ZIP CODE]
Phone: [PHONE NUMBER]
Email: [EMAIL ADDRESS]

☐ Individual
☐ Business (Complete the following if filing as a business):
    Business Type: [CORPORATION/LLC/PARTNERSHIP/SOLE PROPRIETORSHIP]
    DBA Name (if applicable): [DBA NAME]
    Business License No.: [LICENSE NUMBER]
    Tax ID/EIN: [TAX ID NUMBER]

DEFENDANT INFORMATION

Defendant Name: [DEFENDANT FULL LEGAL NAME]
Address: [STREET ADDRESS]
[CITY], [STATE] [ZIP CODE]
Phone (if known): [PHONE NUMBER]
Email (if known): [EMAIL ADDRESS]

☐ Individual
☐ Business:
    Business Type: [CORPORATION/LLC/PARTNERSHIP/SOLE PROPRIETORSHIP]
    DBA Name (if applicable): [DBA NAME]
    Registered Agent (if known): [REGISTERED AGENT NAME]
    Registered Agent Address: [REGISTERED AGENT ADDRESS]

Additional Defendant(s) (if applicable):
Defendant Name: [ADDITIONAL DEFENDANT FULL LEGAL NAME]
Address: [STREET ADDRESS]
[CITY], [STATE] [ZIP CODE]
Relationship to Claim: [DESCRIBE RELATIONSHIP]
Liability: ☐ Joint and Several ☐ Separate

JURISDICTION AND VENUE

1. This Court has jurisdiction over this matter because:

   • The amount in controversy is $[AMOUNT], which is within this Court's small claims jurisdictional limit of $[JURISDICTIONAL LIMIT].
   • The events giving rise to this claim occurred in [COUNTY/CITY] County, [STATE].
   • The Defendant resides in [COUNTY/CITY] County, [STATE].
   • The Defendant conducts business in [COUNTY/CITY] County, [STATE].

2. Venue is proper in this Court because:

   • ☐ The Defendant resides in this county/city.
   • ☐ The incident/transaction occurred in this county/city.
   • ☐ The property that is the subject of this claim is located in this county/city.
   • ☐ Other: [SPECIFY OTHER BASIS FOR VENUE]

3. This claim is being filed within the applicable statute of limitations for this type of case, which is [NUMBER] years in [STATE] for [TYPE OF CLAIM].

STATEMENT OF CLAIM

Amount Claimed: $[EXACT AMOUNT]
Plus Court Costs: $[FILING FEE AMOUNT]
Total Amount: $[TOTAL AMOUNT]

Date(s) of Incident/Transaction: [DATE(S)]
Location of Incident/Transaction: [LOCATION]

Legal Basis for Claim:
☐ Breach of Contract
☐ Property Damage
☐ Unpaid Debt
☐ Security Deposit Dispute
☐ Consumer Protection Violation
☐ Personal Injury
☐ Other: [SPECIFY]

Detailed Statement of Facts:

I, [PLAINTIFF NAME], the Plaintiff in this action, hereby state that the Defendant, [DEFENDANT NAME], is indebted to me in the amount of $[AMOUNT] for the following reasons:

[PROVIDE A CLEAR, CHRONOLOGICAL ACCOUNT OF THE EVENTS LEADING TO THIS CLAIM, INCLUDING ALL RELEVANT DATES, LOCATIONS, AGREEMENTS, AND INTERACTIONS WITH THE DEFENDANT. BE SPECIFIC ABOUT WHAT HAPPENED, WHEN IT HAPPENED, AND WHY THE DEFENDANT OWES YOU MONEY.]

DEMAND FOR PAYMENT HISTORY

Prior to filing this complaint, I have made the following attempts to resolve this matter:

1. On [DATE], I [DESCRIBE FIRST ATTEMPT TO RESOLVE - e.g., "sent a demand letter requesting payment"].

   • Defendant's response: [DESCRIBE RESPONSE OR NOTE "No response received"]

2. On [DATE], I [DESCRIBE SECOND ATTEMPT TO RESOLVE - e.g., "called the Defendant and discussed the matter"].

   • Defendant's response: [DESCRIBE RESPONSE OR NOTE "No response received"]

3. On [DATE], I [DESCRIBE THIRD ATTEMPT TO RESOLVE - e.g., "sent a final demand letter via certified mail"].

   • Defendant's response: [DESCRIBE RESPONSE OR NOTE "No response received"]

Despite these good faith efforts to resolve this matter without court intervention, the Defendant has failed to satisfy their obligation, necessitating this legal action.

EVIDENCE SUMMARY

I intend to present the following evidence to support my claim:

Documents:

1. [DOCUMENT DESCRIPTION - e.g., "Written contract dated [DATE]"]
2. [DOCUMENT DESCRIPTION - e.g., "Receipts/invoices showing payment/services"]
3. [DOCUMENT DESCRIPTION - e.g., "Photographs of damaged property"]
4. [DOCUMENT DESCRIPTION - e.g., "Text messages/emails between parties"]
5. [DOCUMENT DESCRIPTION - e.g., "Demand letters sent to Defendant"]
6. [DOCUMENT DESCRIPTION - e.g., "Certified mail receipts"]
7. [DOCUMENT DESCRIPTION - e.g., "Repair estimates/bills"]

Witnesses:

1. Name: [WITNESS NAME]
   Contact Information: [WITNESS CONTACT INFORMATION]
   Expected Testimony: [BRIEF DESCRIPTION OF WHAT THIS WITNESS WILL TESTIFY ABOUT]

2. Name: [WITNESS NAME]
   Contact Information: [WITNESS CONTACT INFORMATION]
   Expected Testimony: [BRIEF DESCRIPTION OF WHAT THIS WITNESS WILL TESTIFY ABOUT]

Calculation of Damages: [PROVIDE A DETAILED BREAKDOWN OF HOW YOU CALCULATED THE AMOUNT CLAIMED, INCLUDING ANY SPECIFIC COSTS, FEES, INTEREST, OR OTHER COMPONENTS THAT MAKE UP THE TOTAL AMOUNT]

PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that this Court:

1. Enter judgment in favor of the Plaintiff and against the Defendant in the amount of $[AMOUNT];
2. Award court costs in the amount of $[FILING FEE AMOUNT];
3. Award pre-judgment interest at the legal rate from [DATE PAYMENT BECAME DUE] to the date of judgment;
4. Award post-judgment interest at the legal rate from the date of judgment until paid in full; and
5. Grant such other and further relief as this Court deems just and proper.

VERIFICATION

I, [PLAINTIFF NAME], hereby declare under penalty of perjury under the laws of the State of [STATE] that I am the Plaintiff in the above-entitled action; that I have read the foregoing complaint and know the contents thereof; and that the same is true of my own knowledge, except as to those matters stated on information and belief, and as to those matters, I believe them to be true.

Executed on [DATE] at [CITY], [STATE].

[PLAINTIFF NAME], Plaintiff

CERTIFICATION OF PRE-FILING REQUIREMENTS

☐ I certify that I have complied with all pre-filing requirements for small claims actions in this jurisdiction, including:

• ☐ Sending a formal demand letter to the Defendant
• ☐ Attempting mediation or alternative dispute resolution (if required)
• ☐ Waiting the required period after demand before filing
• ☐ Other: [SPECIFY OTHER REQUIREMENTS MET]

SERVICE INFORMATION

I plan to serve the Defendant by: ☐ Certified Mail, Return Receipt Requested ☐ Sheriff/Constable Service ☐ Private Process Server ☐ Other method permitted by court rules: [SPECIFY]

FILING CHECKLIST

☐ Original Complaint for Court ☐ [NUMBER] copies for each Defendant ☐ Copy for Plaintiff's records ☐ Filing fee of $[AMOUNT] or Fee Waiver Application ☐ Completed Summons form (if required) ☐ Self-addressed, stamped envelope (if required for return of filed documents)

Respectfully submitted this [DAY] day of [MONTH], [YEAR].

[PLAINTIFF NAME], Plaintiff