Small Claims Questionnaire Form
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2BOWLING GREEN MUNICIPAL COURT
R.C. 1925
122001
Please PRINT
SMALL CLAIMS QUESTIONNAIRE
Hon. Mark B. Reddin, Judge
PLAINTIFF (Person filing complaint)
Name:
_____________________________________ ______________________________________
Individual
Partnership
Corporation
Individual
Partnership
Corporation
Address: _____________________________________ ______________________________________
_____________________________________ ______________________________________
Tel. (Hm) ____________________ (Wk)____________________ If more Plaintiffs on back X here:
DEFENDANT (Person being sued)
Name:
_____________________________________ ______________________________________
Individual
Partnership
Corporation
Individual
Partnership
Corporation
Address: _____________________________________ ______________________________________
_____________________________________ ______________________________________
Tel. (Hm) ____________________ (Wk)___________________ If more Defendants on back X here:
Military Status. Is the defendant in the military?
Yes
No
I don’t know.
Claim. Place where it occurred (X one):
city
village
township of ________________________,
______________________ County, Ohio.
Facts. A brief statement of the claim (where, when, what, who & how much):
Statement continues on back. Total amount claimed: $_________________.
I waive any amount over the small claims limit of $3,000.00.
DO YOU UNDERSTAND THAT: (1) If you are awarded a judgment and defendant fails to pay it, you
will have to take further action to collect it? (2) Your filing fee will not be returned to you until the losing
party pays the costs (R.C. 1901.26(F))?
Yes
No
I understand that I am required to appear to present my case on the assigned court date. If I fail to appear, I
understand that the case will be dismissed and my deposit will be applied to the costs.
Yes
No
In the event that the certified mail is “unclaimed” or “refused,” please reissue by ordinary mail with
certificate of mailing.
Date _____/_____/_____
__________________________________________
Your signature (title with company)
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