Small Claims Complaint Form
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1Clermont County Municipal Court, Batavia, Ohio
Small Claims Complaint
_____________________________________________
Case No._____________________________________
_____________________________________________
_____________________________________________
In accordance with civil rule 4.6 (C) or (D) and 4.6 (E), an
Plaintiff(s)
Phone Number
ordinary mail waiver is requested
vs.
Amount $_________________________________
_____________________________________________
______________________________________________________
Defendant 2
_____________________________________________
______________________________________________________
Defendant 3
_____________________________________________
Defendant 1
Phone Number
TO THE CLERK:
Please take notice that a claim is hereby filed against the above defendant(s) and request that he/they be summoned to appear in Court to
answer same.
STATEMENT OF CLAIM: ____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Wherefore plaintiff prays judgment against defendant in the sum of ______________________________________________________dollars, plus
interest from the _________ day of _________________________, ______________, at the rate of ____________% per year plus costs.
STATE OF OHIO, COUNTY OF ___________________ SS.
AFFIDAVIT OF COMPLAINANT’S CLAIM
_______________________________________________________, being first duly sworn, on oath states that (s)he is/they are the Plaintiff(s) in the
above entitled cause; that the cause for the payment of money, that the nature of plaintiff’s demand is as stated, and that there is due to plaintiff from the
defendant the amount stated above; defendant(s) is/are not now in the military or naval service of the United States.
X________________________________________________________________________________________________________________________
Signature of Plaintiff/Attorney
Attorney address only
Phone No.
Attorney ID No.
Subscribed and sworn to before me this __________ day of __________________________, 20_______
____________________________________________________
Clerk, Deputy Clerk, Notary Public
NOTICE AND SUMMONS IN ACTION FOR MONEY ONLY
To: (1) _________________________________________
(2) _______________________________________________
_________________________________________
_______________________________________________
_________________________________________
_______________________________________________
_____________________________________________ ask(s) judgment in this Court against you for $_____________________, plus interest from the
_________ day of ___________________________, ____________, at the rate of _________% per year and costs, upon the above claim.
The court will hold trial on this claim at the Clermont County Municipal Courthouse, 4430 State Route 222, Courtroom A, Batavia, Ohio, at
__________a.m/p.m.., on:_______________________________________________________________________
If you do not appear at the trial, judgment may be entered against you by default, and your earnings may be subjected to garnishment, or your
property may be attached to satisfy said judgment. If your defense is supported by witnesses, account books, receipts, or other documents, you must
produce them at the trial. Subpoenas for witnesses will be issued by the clerk upon request only.
If you admit the claim but desire time to pay, you may make such a request at the trial. “IF YOU BELIEVE YOU HAVE A CLAIM AGAINST THE
PLAINTIFF, YOU MUST FILE A COUNTERCLAIM WITH THE COURT AND MUST SERVE THE PLAINTIFF AND ALL OTHER PARTIES WITH A
COPY OF THE COUNTERCLAIM AT LEAST SEVEN DAYS PRIOR TO THE DATE OF THE TRIAL OF THE PLAINTIFF’S CLAIM.”
_______________________________________________________________
Clerk – Deputy Clerk
Small Claims Division
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