Fill and Sign the Statement of Claim District of Columbia Form

Small Claims Form I I: General Superior Court of the District of Columbia CIVIL DIVISION SMALL CLAIMS AND CONCILIATION BRANCH 500 Indiana Ave., N.W. Room ____________ WASHINGTON. D.C. 20001 TELEPHONE 879-1120 _________________________________ (1)_________________________________ Plaintiff _________________________________ vs. (2)_________________________________ _________________________________ Address Zip Code (3)_________________________________ Defendant Phone No. (___)__________ No. SC ___________  Collection Case STATEMENT OF CLAIM District of Columbia ss: _______________________________ being first duly sworn on oath says the foregoing is a just and true statement of the amount owing by the defendant to plaintiff, exclusive of all set-offs and just grounds of defense. _________________________________ _________________________________ Attorney for Plaintiff Plaintiff (or agent) _________________________________ Bar No.__________________________ Address Zip Code Phone No._________________________ Subscribed and sworn to before me this ______ day of ___________________________ (month and year) __________________________ Deputy Clerk (or notary public) NOTICE All parties must notify the court of any address changes. To: (1)_______________________________ (2) _______________________________ Defendant Defendant _________________________________ ________________________________ Home Address Zip Code Home address . I _________________________________ _________________________________ Business Address Business Address You are hereby notified that ________________________________________________ has made a claim and is requesting judgment against you in the sum of ____________________________________dollars ($_______________ ), as shown by the foregoing statement. The court will hold a hearing upon this claim on ________________________________________________________________________ at ___:00 __.m. in the Small Claims and Conciliation Branch located at 500 Indiana Ave., N.W., _______ level. Courtroom ____-____. BRING THIS NOTICE WITH YOU AT ALL TIMES _______________________________ Deputy Clerk Small Claims and Conciliation Branch INSTRUCTIONS TO DEFENDANT(S) IMPORTANT: IF YOU FAIL TO APPEAR AT THE TIME STATED OR AT ANY OTHER TIME THE COURT NOTIFIES YOU TO DO SO, A JUDGMENT BY DEFAULT MAY BE ENTERED AGAINST YOU FOR THE MONEY, DAMAGES OR OTHER RELIEF DEMANDED IN THE STATEMENT OF CLAIM. IF THIS OCCURS. YOUR WAGES OR BANK ACCOUNT MAY BE ATTACHED OR WITHHELD OR ANY PERSONAL PROPERTY OWNED BY YOU MAY BE TAKEN AND SOLD TO PAY THE JUDGMENT. DO NOT FAIL TO APPEAR AT THE REQUIRED TIME. Before any case goes to trial in the Small Claims and Conciliation Branch, a trained mediator will meet with all parties to see if a settlement can be worked out. If all parties are present when your case is called, you and the plaintiff will be able to see a mediator and hopefully settle your dispute without having to go to trial. You may come with or without a lawyer. The Statement of Claim indicates whether the plaintiff has a lawyer. If the plaintiff does have a lawyer and you wish to dispute the claim, it would be in your interest to have your own lawyer. If you wish to have legal advice and feel that you cannot afford to pay a fee to a lawyer, you may contact one of the offices of the Legal Aid Society (628-l 161) Neighborhood Legal Services (628-2700) OR THE D.C. Law Students in Court program (638-4798) for help or come to 500 Indiana Ave., N.W., Room JM-260 for more information concerning places where you may ask for such help. Act Promptly If it is impossible for you to appear on the date of trial, attempt to contact the Plaintiff to arrange a new date. If parties agree on a date, notify the clerk of the Small Claims Branch of this court in person or by phone of the new date. If parties cannot agree, you may contact the clerk who will inform you regarding procedures. If you do not appear on the new date, a judgment may be entered against you. Whenever corresponding with the Small Claims clerk’s office by mail, please include your case number and your date to appear in court. You are given the following additional instructions in the event that you intend to appear without a lawyer. 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 summoned, see the clerk at once for assistance. 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. PUEDE OBTENERSE COPIAS DE ESTE FORMULARIO EN ESPANOL EN EL TRIBUNAL SUPERIOR SEL DISTRITO DE COLUMBIA, 500 INDIAN AVENUE, N.W., SALA _________. YOU MAY OBTAIN A COPY OF THIS FORM IN SPANISH AT THE SUPERIOR COURT OF DC, 500 INDIANA AVENUE N.W., ROOM _______.