Fill and Sign the Statement Claim Draft Form

IN THE MAGISTRATE COURT OF __________________________________ COUNTY STATE OF GEORGIA _______________________________________ _______________________________________ _______________________________________ Plaintiff(s) vs. Civil Action No. _______________ _______________________________________ _______________________________________ _______________________________________ Defendant(s) _______________________________________ Telephone STATEMENT OF CLAIM  Suit on a Note  Suit on Account  Other __________________________________ 1. The Court has jurisdiction over the Defendant because:  the Defendant is a resident of ___________________________________ County; or  other (please specify) ______________________________________________________________________________ _____________________________________________________________________________. 2. Plaintiff claims the Defendant is indebted to the Plaintiff as follows: 3. That said claim is in the amount of $______________ principal, $_______________ interest, plus $____________ costs to date; and all future costs of this suit. State of Georgia, __________________________________ County: ____________________________________ being duly sworn on oath, says the foregoing is a just and true statement of the amount owing by defendant to plaintiff, exclusive of all set-offs and just grounds of defense. Sworn and subscribed before me this ____________________________________ _____ day of _______________, 20____. Plaintiff or Agent ____________________________________ __________________________________ (If agent - title or capacity) Notary Public, Deputy Clerk Phone No. ___________________________ Civil Complaint 07/18/00 NOTICE AND SUMMONS TO: ____________________________________ ____________________________________ You are hereby notified that the above-named plaintiff has made a claim and is requesting judgment against you in the sum shown by the foregoing statement. YOU ARE REQUIRED TO FILE OR PRESENT AN ANSWER TO THIS CLAIM WITHIN 30 DAYS AFTER SERVICE OF THIS CLAIM UPON YOU. IF YOU DO NOT ANSWER, JUDGMENT BY DEFAULT WILL BE ENTERED AGAINST YOU. YOUR ANSWER MAY BE FILED IN WRITING OR MAY BE GIVEN ORALLY TO THE JUDGE, BUT ONLY IN OPEN COURT IN PERSON WITHIN THE 30 DAY PERIOD. NO TELEPHONE ANSWERS ARE PERMITTED. The court will hold a hearing upon this claim at the ________________________ County Courthouse, __________________________________, _________________________, Georgia, at a time to be set after your answer is filed. You may come with or without an attorney. If you have witnesses, books, receipts, or other writings bearing on this claim, you should bring them with you at the time of the hearing. If you wish to have witnesses subpoenaed, see the court at once for assistance. If you have a claim against the plaintiff, you should notify the court and file a written answer and counterclaim immediately. If you admit the claim but desire additional time to pay, you must come to the hearing in person and state the circumstances to the court. Filed this _____ day of _____________________________, 20_____. ______________________________________________________ Magistrate or Deputy Clerk, _____________________ County, Georgia Civil Complaint 07/18/00