Fill and Sign the Statement of Claim Bartow County Form

M AGISTRATE COURT OF ______________COUNTY, GEORGIA Date Filed ________________ Case No: _______________ STATEM ENT OF CLAIM Plaintiff(s) Name , Addre ss vs ______________________________________________ ______________________________________________ De fe ndant(s) Name , Addre ss ANSWER / COUNTERCLAIM OF DEFENDANT(S) [ ] [ ] [ ] 1. I adm it the claims of the Plainti ff. 2. I request a paym ent schedul e. 3. I deny the claim of Plainti ff(s) as follows: (Attach additional sheets as needed.) 4. I counterclaim against the Plaintiff(s) as follows: ( You must i nclude a brief statement giving reasonable notice of the basi s for each claim contained in the counterclaim. Attach additional sheets as needed.) __________________________ being first duly sworn on oath says the facts set forth in the foregoing Answer (and/or Countercla im) are true and correct. Sworn to and subscribed before me this _____ day of ______________________ _____, 20 ____. _____ __________________________________ [ ] Defendant [ ] Defendant’s Agent ____________________________________________ Deputy Clerk / Notary Public M AGISTRATE COURT OF ______________COUNTY, GEORGIA Date Filed ________________ Case No: _______________ STATEM ENT OF CLAIM ANSWER / COUNTERCLAIM OF DEFENDANT(S) Additional Info for: Denial of Claim Counterclaim M AGISTRATE COURT OF ______________COUNTY, GEORGIA Date Filed ________________ Case No: _______________ STATEM ENT OF CLAIM ANSWER / COUNTERCLAIM OF DEFENDANT(S) Additional Info for: Denial of Claim Counterclaim