Small Claims Court Complaint Form Template

This Small Claims Court Complaint Form (“Form”) is submitted to the [Court Name], [County/State], by the undersigned Plaintiff.

1. Court Information

Court Name: [Court Name]
Court Address: [Street, City, State, ZIP]
Case Number (assigned by court): [Leave blank for clerk]

2. Plaintiff Information

Full Legal Name: [Plaintiff Name]
Address: [Street, City, State, ZIP]
Phone: [Number]
Email: [Address]

3. Defendant Information

Full Legal Name: [Defendant Name]
Address: [Street, City, State, ZIP]
Phone: [Number]
Email: [Address]

4. Claim Information

Amount of Claim: $[Amount]
Reason for Claim: [Brief description, e.g., “Unpaid loan of $2,000 dated [Date]”]
Date Claim Arose: [Date]
Location of Event/Transaction: [City/County]

5. Statement of Claim

The Plaintiff states the following facts in support of this claim:
[Provide concise but detailed statement of events leading to the dispute. Example: “On [Date], Defendant borrowed $2,000 from Plaintiff under an agreement to repay within 30 days. Defendant has failed to repay despite multiple requests.”]

6. Relief Requested

Plaintiff requests judgment against the Defendant for the claim amount stated above, plus allowable court costs and interest, as permitted by law.

7. Certification

I, the Plaintiff, certify that the information in this complaint is true and correct to the best of my knowledge, and that the amount claimed does not exceed the jurisdictional limit for small claims in this court.

Date: ________________________
Plaintiff Signature: ________________________

8. Clerk Use Only

Filing Fee Paid: $__________
Date Filed: ____________________
Clerk’s Initials: _____________