Notice of Claim

IN THE DELAWARE CIRCUIT COURT NO. ____SMALL CLAIMS DIVISION

DELAWARE COUNTY JUSTICE CENTER

3100 S. TILLOTSON AVE., MUNCIE, IN 47302

CAUSE NO. 18C0___-___________________________

Plaintiff(s)

Address

City/State/Zip

Telephone No. & email

NOTICE OF CLAIM

AGAINST

Defendant #1

Address

City/State/Zip

Telephone No.

Defendant #2

Address

City/State/Zip

Telephone No.

YOU ARE NOTIFIED THAT THE PLAINTIFF(S) HAS FILED A SMALL CLAIMS LAWSUIT AGAINST YOU IN THE AMOUNT OF $_______________, TOGETHER WITH COURT COSTS IN THE AMOUNT OF $____________. A BRIEF STATEMENT OF THE PLAINTIFF’S CLAIM FOLLOWS:

Signature: _________________________________ Printed Name ________________________________

YOU ARE ADVISED THAT THE ABOVE CLAIM IS SCHEDULED FOR INITIAL TRIAL ON THE ____DAY OF _________________________, 201__

AT __________ ____.M. IN THE DELAWARE CIRCUIT COURT NO. __ AT THE ABOVE-LISTED ADDRESS. (**See Additional Information Regarding the Initial Trial on the Reverse Side of this Form)

Dated: _______________

Clerk:_______________________________________________

THE FOLLOWING MANNER OF SERVICE IS HEREBY DESIGNATED:

As to Defendant #1:

Certified mail: ________________

Personal service:_______________

As to Defendant #2

Certified mail:________________

Personal service:______________

Additional Defendants:

Certified mail:_________________

Personal mail:_________________