THIRD JUDICIAL DISTRICT, STATE OF IDAHO FILED _______________AT_____.M.
WASHINGTON COUNTY CLERK OF
THE DISTRICT COURT
SMALL CLAIMS DEPARTMENT BY _____________________,Deputy
____________________________________, )
Case No. _____________________
)
____________________________________,
) CLAIM
Plaintiff(s), )
vs. ) $________Claim
) $________Filing Fee
____________________________________, )
$________Service Fee*
) $________Another Notice
____________________________________, )
$________
Defendant(s).
) $________TOTAL
____________________________________________________________________________
Plaintiff’s
Name Address City State Zip Phone
____________________________________________________________________________
Plaintiff’s
Name Address City State Zip Phone
____________________________________________________________________________
Defendant’s
Name Address City State Zip Phone
____________________________________________________________________________
Defendant’s Name Address
City State Zip Phone
If you are seeking a judgment for money:
AMOUNT OF CLAIM: $_________________ (not
including filing and service fees)
DATE CLAIM AROSE: ____________________ (month
and year)
BASIS FOR YOUR CLAIM:
_____________________________________________________
___________________________________________________________________________
If you are seeking a judgment for the return of personal property:
I am the
owner, or I am entitled to possess, the following personal
property which is being held by defendant (specifically describe the
property):
____________________________________________________________________________
___________________________________________________________________________
__________________________________ VALUE OF THE PROPERTY: $_______________
* Service of process by certified mail requested: ___ Yes ___ No
BY SIGNING THIS CLAIM, THE PLAINTIFF VERIFIES THAT 1) the
plaintiff is the
true owner of the claim, 2) the defendant resides in ______________ County,
or the defendant resides outside Idaho and the claim arose in _____________
County, and 3) the information above is true and correct to the plaintiff’s
best knowledge.
________________________________
Favor
de avisarnos antes de la audencia Plaintiff’s Signature
si usted necesitara un interprete
en la
corte.
Subscribed and sworn to before me on ________________________.
________________________________
Deputy
Clerk or Notary Public
My commission expires: