Can I e-sign the Statement of Claim?

Yes. Electronic signatures are legally valid under the ESIGN Act and applicable state law when intent and attribution are demonstrable. Ensure the court accepts electronic filings and retain an audit trail showing signer identity and timestamps.

What if the defendant cannot be located?

If standard service attempts fail, courts may allow substituted service, publication, or other methods set by local rules. Document your efforts and consult the court clerk for authorized alternate service procedures.

Do I need an attorney to file?

No. Small claims procedures are designed for self-representation, but attorneys can assist with complex jurisdictional questions, evidence strategy, or post-judgment collection actions where appropriate.

Will filing start interest on the claim?

Interest accrual depends on the legal basis for the claim and statutory rates; include interest in the amount claimed only if supported by contract or statute and calculate it clearly in your submissions.

How should I serve the defendant?

Follow Minnesota court rules for service, which typically require personal delivery, certified mail, or other court-approved methods; file proof of service promptly to avoid delays.

What records should I retain after filing?

Keep the filed statement, proof of service, all exhibits, and the court’s decision. Retain these for at least three years after resolution; longer retention may be required for tax or healthcare records.

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Minnesota Small Claims Court Statement of Claim

Minnesota Small Claims Court Statement of Claim

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Small Claims Court Statement of Claim

Minnesota Department of Labor and Industry
Workers' Compensation Division
443 Lafayette Road North
St Paul, MN 55155
(651) 284-5030 or 1-800-342-5354 (DIAL-DLI)

S C 0 1

1. Employee's Social Security Number

2. Date(s) of Claimed Injury (mm/dd/yyyy)

3. Claim No.

See Instructions on Reverse Side

DO NOT USE THIS SPACE

Private or confidential data which you supply on this form will be used to process your workers' compensation file. You may refuse to supply the data, but your request may be delayed, or under Minn. Stat. Sec. 176.275, the Department may refuse to accept any formal document that lacks identifying information. This data may be supplied to employers and insurers for the claimed date of injury, the Department of Revenue, the Department of Health and the Workers' Compensation Reinsurance Association. It may also be used in workers' compensation hearings and for state investigations and statistics.

4. Employee

VS.

6. Employer

7. Insurer

Small Claims Court

Statement of Claim

Original Claim and Affidavit of Service

NOTE - File with Division

STATEMENT OF CLAIM

8. Indemnity Benefits (temporary total, temporary partial, permanent total, permanent partial)

9. Medical Benefits

10. Rehabilitation Benefits

11. Other

12. Brief statement of issue(s) in dispute:

13. Brief statement of Defense(s) to the claim

14. Potential Interveners:

All parties must agree to submit to the jurisdiction of the Small Claims Court without right to appeal for this matter by signing below:

15. Date:

16. Employee

17. Insurer, or Self-insured Employer

Instructions

Complete the Statement of Claim form including Social Security Number, all dates of injury relevant to this claim, and a brief explanation of issues in dispute. A doctor's report supporting the claim should be attached unless the claim involves only non-medical issues. Other information in support of the claim may likewise be attached to the form.

All parties must sign the form agreeing to the jurisdiction of the Small Claims Court with no right to appeal any decision which might be rendered by the Small Claims Court.

If other parties have paid benefits to the employee as a result of the work-related injury, indicate the name and address of such parties in the space entitled "possible third party interveners" (e.g., Health Insurance Companies, Medicare, Unemployment Benefit agencies, state rehabilitation agencies, etc.).

Serve or mail a copy of the Small Claims Court Statement of Claim to each party and to each possible third-party intervener.

File the Original Statement of Claim with the Department of Labor and Industry.

This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (651) 284-5030 or 1-800-342-5354 (DIAL-DLI)/Voice or TDD (651) 297-4198.

ANY PERSON WHO, WITH INTENT TO DEFRAUD, RECEIVES WORKERS' COMPENSATION BENEFITS TO WHICH THE PERSON IS NOT ENTITLED BY KNOWINGLY MISREPRESENTING, MISSTATING, OR FAILING TO DISCLOSE ANY MATERIAL FACT IS GUILTY OF THEFT AND SHALL BE SENTENCED PURSUANT TO SECTION 609.52, SUBDIVISION 3.

What the Minnesota Small Claims Court Statement of Claim Is

The Minnesota Small Claims Court Statement of Claim is a standardized court form used to start a civil action for monetary relief in Minnesota's small claims or conciliation process. It identifies the parties, states the amount sought, and summarizes the factual basis for the claim. The form is submitted to the appropriate county court clerk and becomes the official pleading used to schedule a hearing, provide notice to the defendant, and record the case for the court file and service of process.

Why a Proper Statement of Claim Matters

A clear, complete Statement of Claim defines the dispute, preserves deadlines, and supports enforcement of any judgment entered by the court. Accurate forms reduce the risk of dismissal, avoid service problems, and improve the court's ability to schedule and resolve the case efficiently.

Who Typically Files a Minnesota Small Claims Statement of Claim

Individuals and small businesses file this form when seeking damages or payment in amounts handled in small claims or conciliation proceedings.

Individual consumers pursuing unpaid debts, damages, or refunds in a local county court
Small business owners or sole proprietors seeking unpaid invoices or breach-of-contract recovery
Landlords or tenants asserting lease-related monetary claims or security deposit disputes

Filers include unrepresented claimants and attorneys acting for clients; the form is designed to be completed without specialized legal software.

Key components of a professional Statement of Claim

A well-prepared form is complete, legible, and supported by organized exhibits. It should identify parties, state specific relief requested, and attach concise evidence to allow the court and defendant to understand the basis for the claim.

Caption

Court name, county, case number (if assigned), and party designations placed at the top of the form to identify jurisdiction.

Plaintiff details

Full legal name, mailing address, daytime phone, and email for the person or business bringing the claim.

Defendant details

Name and best-known address for the person or entity being sued; include business DBA where applicable.

Amount claimed

Exact dollar amount sought, including principal, fees, interest, and calculation method shown or summarized.

Statement of facts

Clear chronology of events with dates and locations that explain why the defendant owes the specified amount.

Attachments

Copies of contracts, invoices, receipts, photographs, or written communications that substantiate the claim amount.

Essential information required on the form

Plaintiff name: Full legal name

Defendant name: Full legal name

Claim amount: Exact dollar total

Incident date: Date of loss or breach

Supporting files: List attachments

Signature/date: Signer and execution date

Step-by-step: completing and filing the Minnesota Statement of Claim

Follow these steps in order to prepare a complete filing, serve the defendant, and secure a hearing date with the court clerk.

01

Prepare form: Complete all required fields accurately.
02

Attach evidence: Include copies of contracts and invoices.
03

File with clerk: Submit to county court clerk for filing.
04

Serve defendant: Deliver notice per court rules.

Configuring an online filing workflow

When using an online tool to prepare and submit the Statement of Claim, confirm file formats, signer fields, and notification settings before submission.

Field	Configuration
Upload document	PDF or DOCX with readable text
Signature fields	Place signature and date fields where required
Authentication	Email or SMS code for signer identity
Notifications	Automatic copy to plaintiff and clerk

Where to file and how the form moves through the court

The court clerk accepts the completed Statement of Claim, assigns a case number, and issues instructions for service and the hearing; the process then follows local court rules.

File with clerk: Submit in person, by mail, or via e-filing if available
Case number: Court assigns a number and calendar date
Service: Plaintiff completes authorized service methods
Hearing: Court holds a hearing or conference per schedule

Digital signing and technical requirements

Use a platform that supports PDF and DOCX, produces an audit trail, and meets required authentication methods for court filings.

File formats: PDF, Word DOCX supported
Authentication: Email or SMS code options
Audit trail: Timestamp and signer IP logged

Timing to consider when filing a small claims case

Timely filing and service preserves your claim and prepares you for the court schedule. Local rules and statutes of limitations determine the outer deadlines.

Statute of limitations:

Varies by claim type; consult state law

File promptly:

File as soon as dispute remains unresolved

Service timing:

Service must follow court rules for notice

Hearing date:

Court assigns date after filing and service

Post-judgment:

Follow local procedures to collect or appeal

Consequences of errors or incomplete filings

Dismissal risk: Case may be dismissed

Default judgment: Defendant may default if service succeeds

Sanctions: Court may award costs or sanctions

Collection limits: Enforcement may be harder with errors

Delay: Incorrect filings cause scheduling delays

Appeal restriction: Procedural defects limit relief

eSignature solution comparison for preparing and signing court documents

Basic vendor features and pricing help evaluate eSignature providers for document preparation and service. Pricing and feature availability vary by plan and billing terms.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Common mistakes to avoid when preparing a claim

Using an incorrect defendant name or address causes failed service and delays in adjudication of the claim.
Omitting key dates or failing to show how the amount was calculated weakens the court’s ability to evaluate the claim.
Submitting unsigned or incorrectly signed forms may lead the clerk to reject or return the filing for correction.
Relying on incomplete evidence or failing to attach key documents often results in a weaker case at the hearing.

Practical tips for accurate and efficient filings

Follow a consistent checklist and retain copies of every filed document and proof of service to support case management and any post-judgment steps.

Prepare a checklist

Create a short filing checklist including defendant name, address, total amount, exhibits list, signature, and service method to avoid omissions and ensure completeness.

Organize evidence chronologically

Number exhibits and reference them in your statement of facts so the judge and opposing party can follow the timeline without confusion.

Confirm service methods

Use court-approved service methods and retain proof of service; incorrect service is a frequent basis for dismissal or delayed hearings.

Keep digital and paper copies

Store a certified electronic copy and a paper backup for the case file to simplify follow-up enforcement or appeals.

Two real-world examples of common small claims filings

The scenarios below illustrate typical Statement of Claim uses and how concise documentation supports resolution at hearing.

Unpaid Rent Dispute

Tenant failed to pay rent after notices were sent

Claim seeks unpaid rent and late fees
Plaintiff attached lease, payment ledger, photos of property, and copies of prior notices to support the requested amount and show effort to resolve before filing.

Small Contractor Claim

Contractor was not paid for completed work

Claim requests invoice amount plus interest
The claimant included the contract, signed change orders, invoice copies, and before/after photos to substantiate completion and damages.

Frequently asked questions about the Minnesota Statement of Claim

Answers to common procedural and technical questions about completing, serving, and submitting a small claims Statement of Claim in Minnesota.

Need help? Contact support

Can I e-sign the Statement of Claim?
Yes. Electronic signatures are legally valid under the ESIGN Act and applicable state law when intent and attribution are demonstrable. Ensure the court accepts electronic filings and retain an audit trail showing signer identity and timestamps.
What if the defendant cannot be located?
If standard service attempts fail, courts may allow substituted service, publication, or other methods set by local rules. Document your efforts and consult the court clerk for authorized alternate service procedures.
Do I need an attorney to file?
No. Small claims procedures are designed for self-representation, but attorneys can assist with complex jurisdictional questions, evidence strategy, or post-judgment collection actions where appropriate.
Will filing start interest on the claim?
Interest accrual depends on the legal basis for the claim and statutory rates; include interest in the amount claimed only if supported by contract or statute and calculate it clearly in your submissions.
How should I serve the defendant?
Follow Minnesota court rules for service, which typically require personal delivery, certified mail, or other court-approved methods; file proof of service promptly to avoid delays.
What records should I retain after filing?
Keep the filed statement, proof of service, all exhibits, and the court’s decision. Retain these for at least three years after resolution; longer retention may be required for tax or healthcare records.

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