Notice Of Claim, Summons To Appear, And Notice Of Trial Form
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1
2STATE OF INDIANA
)
SHELBY SUPERIOR COURT II
)SS:
COUNTY OF SHELBY
)
CAUSE NO. 73D02-_______________________________
Plaintiff Name___________________________________
Defendant__________________________________________(et al)
Address___________________________________________
Address__________________________________________________
Address __________________________________________
Address__________________________________________________
City State Zip _____________________________________
City State Zip ____________________________________________
Telephone ________________________________________
Telephone_______________________________________________
Email______________________________________________
Email_____________________________________________________
Plaintiff requests service by:
Sheriff of _________________________________________________County ($25, paid in advance)
Certified mail
NOTICE of CLAIM, SUMMONS to APPEAR, and NOTICE OF TRIAL
Plaintiff’s Claim is for $____________________________ dollars plus court costs $______________ for:
You (the Defendant) are being sued by the Plaintiff whose name appears above.
Goods/ Services/ Money Loaned/ Damages / Check / Note / Breach of Contract
(check
Eviction and Possession / Back Rent and Damages
&
Other____________________________________________________________________________________________.
circle)
A brief statement of the nature of the Plaintiff’s claim against you is as follows:
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Shelby County Superior Court 2, 407 S. Harrison Street, Shelbyville, IN 46176. If you fail to appear in
Trial for the lawsuit is scheduled for _____________________________________________ at _______________ o'clock in
person or by an attorney the Court may enter a default judgment against you.
Dated ______________________________, 20_____
(See important information on reverse side)
_______________________________________________________
Plaintiff or attorney’s signature (Bar # if attorney)
You may contact the Plaintiff's attorney at:
Plaintiff Signature
_____________________________________________________
_____________________________________________________
_____________________________________________________
(_______)____________________________________________
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