215 N. GRANT STREET
WOOSTER, OH 44691
(330) 287-5668
SMALL CLAIMS INFORMATION SHEET
Date: _________________________
PLAINTIFF __________________________________ DEFENDANT _______________________________
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Address ____________________________________ Address ___________________________________
City _______________________________________ City ______________________________________
State ____________________ Zip _______________ State __________________ Zip ________________
Telephone __________________________________ Telephone _________________________________
Email address _______________________________ Email address ______________________________
Is DEFENDANT presently in the military or naval service of the United States? Yes _________ No ___________
Complaint__________________________________________________________________________________________
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AMOUNT CLAIMED $ _______________________WITH INTEREST AT THE RATE OF _____________________%
FROM THE ___________________DAY OF _______________________________________ 20 _____________
The above complaint is true to the best of my belief.
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Prepared by:
