Debt Claim Petition Packet



Similar documents
THE 508 SERIES - DEBT CLAIM CASES

INSTRUCTIONS AND INFORMATION FOR FILING SMALL CLAIMS/DEBT CLAIMS CASES IN JUSTICE COURT

How To File A Civil Suit In Texas

PART V - RULES OF PRACTICE IN JUSTICE COURTS. [RULES 523 to 591. Repealed effective August 31, 2013] RULE 500. GENERAL RULES

MOHAVE COUNTY JUSTICE COURT. If you want to file a SMALL CLAIMS ANSWER

Form DC-421 SUMMONS FOR UNLAWFUL DETAINER Form DC-421

Judge Steve Seider Justice of the Peace Precinct 3, Place 2 Dallas County, Texas

Civil Suits: The Process

IN THE SUPREME COURT OF TEXAS

Frequently Asked Questions Foreclosure

CIVIL PRACTICE AND PROCEDURE GARNISHMENT CHAPTER 77

JUSTICE COURT # 2 GRAHAM COUNTY STATE OF ARIZONA P.O. BOX 1159, 136 WEST CENTER STREET, PIMA AZ PHONE (928) FAX (928)

FOR USE IN THE MARION COUNTY SMALL CLAIMS COURTS

PROSECUTING AND DEFENDING A SMALL CLAIMS CASE. Instructions Sample Forms Rules Statutes. Effective June 7, 2005

How To Process A Small Claims Case In Anarizonia

January 9, The Self Help Legal Center. Southern Illinois University School Of Law Carbondale, IL (618)

SMALL CLAIMS RULES. (d) Record of Proceedings. A record shall be made of all small claims court proceedings.

SMALL CLAIMS COURT INFORMATION

Updated September, 2006

Cause No.: Application for an Expedited Order Under Rule 736 on a Home Equity, Reverse Mortgage, or Home Equity Line of Credit Loan

SMALL CLAIMS PROCEDURE

TEXAS RULES OF CIVIL PROCEDURE

SMALL CLAIMS COURT IN ARKANSAS

PIERCE COUNTY DISTRICT COURT 930 TACOMA AVE S, Room 239, TACOMA, Small Claims Information

INSTRUCTIONS FOR FORCIBLE ENTRY AND DETAINER (FED)/EVICTION

Adams County. Small Claims Manual. (September 2003) Adams County. (Revised July, 2013)

Frequently Asked Questions about Garnishments/Judgments

TEXAS RULES OF CIVIL PROCEDURE

Small Claims. Manual (2014) Indiana Judicial Center 30 South Meridian Street, Suite 900 Indianapolis, Indiana

Small Claims Court Information provided by Oregon State Bar

WHAT IS SMALL CLAIMS COURT?

New Jersey Lawyers Website: Tel: (201) Fax: (201) Hudson Street Hackensack, New Jersey 07601

CIRCUIT COURT OF JACKSON COUNTY, MISSOURI

CHAPTER GARNISHMENT

General District Courts

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM (c), SUPPLEMENTAL PETITION FOR MODIFICATION OF ALIMONY (11/15)

Missouri Small Claims Court Handbook. The Missouri Bar Young Lawyers' Section

Information for Residential Tenants

Pre-Judgment: Basic Steps to Small Claims Service

In the United States District Court for the Northern District of Georgia Atlanta Division

GLOSSARY OF COLLECTION LAW TERMINOLOGY

Small Claims Court in Michigan

Justice Court Rules of Civil Procedure: Table of Contents

GENERAL INFORMATION ON SMALL CLAIMS COURT

Form DC-402 WARRANT IN DEBT SMALL CLAIMS DIVISION Page: 1

IN THE SUPERIOR COURT OF STATE OF GEORGIA. File No., Defendant. COMPLAINT FOR MODIFICATION OF CHILD SUPPORT

What Happens If I Cannot Keep Up With My Debt Payments?

To help you better understand the foreclosure process, these definitions are presented in a logical order, rather than alphabetical order.

SMALL CLAIMS DIVISION INFORMATION

LOCAL RULES FOR THE JUSTICE OF THE PEACE COURTS TARRANT COUNTY, TEXAS EFFECTIVE 01/01/2012

GARNISHMENT PROCEDURE GUIDELINES AND FORMS (INSTRUCTIONS FOR THE PLAINTIFF) JUDGES AND COURT CLERK PERSONNEL ARE NOT PERMITTED TO GIVE LEGAL ADVICE

PROCEDURES FOR PLAINTIFFS IN CIVIL CASES

January 9, The Self Help Legal Center. Southern Illinois University School Of Law Carbondale, IL (618)

!" #$ % # $ ##!# & '((!) * % ( * % '+ ( ((* % ,-- (- (. ) * % '(. ). * % () ) ( / &0#!!0 &102!

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF VIRGINIA Richmond Division

REPOSSESSION TIME LINE

LANDLORDS AND TENANTS. Rent Escrow

Updated: March 10, 2005

FALSE CLAIMS ACT STATUTORY LANGUAGE

TENANTS AND FORECLOSURE: QUESTIONS AND ANSWERS ABOUT RIGHTS FOR LOUISVILLE RENTERS

Execution of Sheriff s Levy F.S. 30, 55 & 56

Limited Action Suits

INTRODUCTION TO SMALL CLAIMS COURT TABLE OF CONTENTS

EARLY CARE & EDUCATION LAW UNIT WHAT YOU NEED TO KNOW ABOUT SMALL CLAIMS COURT

RULE 12 - DOMESTIC RELATIONS / MAGISTRATE S OFFICE

STATE OF INDIANA ) IN THE HOWARD COURT ) SS: COUNTY OF HOWARD ) CAUSE NO.: APPEARANCE BY ATTORNEY IN CIVIL CASE

Breaking Down Small Claims

Small Claims Handbook A citizen s guide to handling small claims complaints in Kentucky

HOW TO REPRESENT YOURSELF IN CIVIL CASES IN JUSTICE COURT

CHAPTER FORECLOSURE OF REAL ESTATE MORTGAGES BY ACTION

CODING: Words stricken are deletions; words underlined are additions. hb

Frequently Asked Questions (FAQs) in South Carolina Master-in-Equity Court

LANDLORD S GUIDE TO NONPAYMENT SUMMARY PROCEEDINGS

Your Rights as a Landlord or Tenant in Illinois

"# $% & $ % $$ "$ ' '((!) * % ( * % '+( ((* % ,-- (- (. ) * % () ) ( / &0#!!0 &102!

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA

1 INSTRUCTION SHEET FOR GARNISHMENTS. Garnishment and Execution Documents

INFORMATION FOR FILING AND DEFENDING A CIVIL CASE IN JUSTICE COURT

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF VIRGINIA Norfolk/Newport News Division

ALL SMALL CLAIMS SERVICE

Chapter 213. Enforcement of Texas Unemployment Compensation Act... 2 Subchapter A. General Enforcement Provisions... 2 Sec

IN THE COMMON PLEAS COURT, PREBLE COUNTY, OHIO

CHAPTER 702 FORECLOSURE OF MORTGAGES, AGREEMENTS FOR DEEDS, AND STATUTORY LIENS Deficiency decree; common-law suit to recover deficiency.

Chapter 153. Violations and Fines 2013 EDITION. Related Laws Page 571 (2013 Edition)

Terms and Definitions. Used in family law in Nova Scotia

2 Proposed Amendments to Rules 735 and 736 of the

Foreclosure / Quiet Title / Partition (216) Fax: (216) Courthouse Square 6th Floor 310 W. Lakeside Ave. Cleveland, OH 44113

SMALL CLAIMS COURT PROCESS

LANDLORDS AND TENANTS IN THE DISTRICT COURT OF MARYLAND. (Sections 8-118, 8-211, and of the Real Property Article, Maryland Annotated Code)

CLEVELAND HEIGHTS MINICIPAL COURT COLLECTING YOUR JUDGMENT. A. DEANE BUCHANAN, JUDGE 40 Severance Circle, Cleveland Heights, OH 44118

SECOND AMENDED ORDER DESIGNATING ALL CASES E-FILE AND SETTING FORTH CERTAIN REQUIREMENTS IN E-FILE CASES

CLARK COUNTY CIVIL LAW RESOURCE CENTER INSTRUCTIONS FOR PREPARING THE

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH

GEORGIA GARNISHMENT LAW Statutory Supplement

Claiming your exempt funds in a bank account garnishment

SUPREME COURT OF PENNSYLVANIA DOMESTIC RELATIONS PROCEDURAL RULES COMMITTEE RECOMMENDATION 140

Sangamon County Circuit Clerk Anthony P. Libri. Small Claims Court Manual

CLERK OF COURT COUNTY OF ORANGEBURG PO DRAWER 9000 ORANGEBURG SC

Transcription:

Debt Claim Petition Packet Judge Michael C. Roach Justice Court Stephens County Courthouse 200 West Walker / 3 rd Floor Breckenridge, TX 76424 Phone#: 254.559.5322 Fax#: 254.559.1127 Justice Court, Precinct One 01/01/2015

PLEASE READ CAREFULLY FOR INFORMATION ON PROCEDURAL RULES IN JUSTICE COURTS, PLEASE CONSULT PART V OF THE TEXAS RULES OF CIVIL PROCEDURE, WHICH IS AVAILABLE ONLINE, AND IN THIS COURT. THE FOLLOWING INFORMATION IS FURNISHED TO YOU AS A COURTESY. NEITHER I, NOR MY CLERK CAN ADVISE YOU WHAT YOU SHOULD DO AND ARE BARRED BY LAW FROM GIVING YOU LEGAL ADVICE. WE CAN ONLY ANSWER PROCEDURAL QUESTIONS. PLEASE READ CAREFULLY BEFORE COMPLETING THE STATEMENT OF CLAIM. 1. SMALL CLAIMS CASE: A small claims case is a lawsuit brought for the recovery of money, damages, civil penalties, personal property, or other relief allowed by law. The claim can be for no more than $10,000, excluding attorney fees, if any. 2. DEBT CLAIM CASE: A debt claim case is a lawsuit brought to recover a debt by an assignee of a claim, a debt collector or collection agency, a financial institution, or a person or entity primarily engaged in the business of lending money at interest. The claim can be for no more than $10,000, excluding statutory interest and court costs but including attorney fees, if any. Please determine which of the above case type is the correct one. Complete the appropriate petition packet. PLEASE PRINT CLEARLY! You are the plaintiff and the person or entity you are suing is the defendant. The defendant has the right to be sued in the county and precinct where they reside; there are exceptions to this rule. Should there be a motion by the defendant to transfer venue, a hearing will be set to determine if a transfer will be granted; a motion to transfer venue may delay the proceedings six to eight weeks. IT IS YOUR RESPONSIBILITY AS PLAINTIFF TO DETERMINE THE LEGAL CAPACITY IN WHICH YOU WILL SUE THE DEFENDANT. It is important that you understand that for any potential judgment you may receive to be valid, it is necessary for you to sue the defendant in their proper legal capacity, of which there are typically three: A. PERSONALLY: Where an individual is responsible to you for damages he may have caused you as an individual. B. PROPRIETOR OR PARTNERSHIP: A business that is not incorporated but does have on file with the County Clerk an assumed name. Example: John Smith d/b/a Greenhouse Supplies. C. CORPORATION: The business which has allegedly caused you damage is incorporated and therefore it is necessary to know the individual s name who is authorized to accept service on behalf of the corporation. The authorized agent for service would be listed with the Secretary of State whose phone number is 1-800- 252-5555 web address is www.sos.state.tx.us. Example: Greenhouse, Inc. through its agent, John Smith. It is also possible for an incorporated entity to have an assumed name. Example: Greenhouse, Inc. d/b/a Greenhouse Supplies.

After the appropriate packet is completed submit it to the clerk for processing. You will then be required to pay the fees for filing the claim and service of citation in the amount of $116.00 for one individual or entity. Each additional person or entity to be served will be an additional $75.00 provided all parties to be served are located in Stephens County. A citation along with a copy of your statement will be served to the defendant(s) by the Constable or Sheriff s deputy notifying them that a suit has been filed against them in this court. The citation will order the defendant(s) to appear in this court to answer to the suit within 14 days of service of citation. The defendant(s) is required to send a copy of their answer to you as plaintiff and one of the following will take place: A. The defendant has entered a denial and the case is set for trial. The trial notice will be mailed approximately 45 days prior to the trial date, or B. The defendant did not answer and a prove-up hearing needs to be set for you to present facts to the court as to why you should be granted a default judgment. C. The defendant answered and acknowledged his indebtedness. An acknowledged judgment is prepared and mailed to both parties. If you should receive a judgment, please understand that this court does not collect the judgment for you, nor can we force the defendant to pay the judgment. It is your responsibility to request any post-judgment remedies. Following are some of those remedies that are available to you: A. Abstract of Judgment places a lien on any real property the defendant may own in a particular county where the abstract is recorded. There is a fee of $5.00 for the court to issue the abstract. You will also be required to pay a small fee to the County Clerk to record the abstract. This may be obtained 21 days after the judgment was signed. B. Writ of Execution authorizes the Constable or Sheriff to seize any assets belonging to the defendant that are not exempt under Texas Property Code, 42.001 and 42.002. Those assets are then auctioned at a public sale and those proceeds are applied to the judgment. This may be obtained thirty (30) days after the judgment was signed. C. Writ of Garnishment is a separate suit wherein you are the plaintiff and the defendant s bank is the defendant. You are actually suing the bank in which the original defendant has his bank account, warning the bank to freeze the monetary assets of his bank account and to appear and make answer to the garnishment suit. Extreme caution should be used when filing a garnishment suit. If there are not sufficient funds in the account at the time the garnishment is served, the person filing the suit is liable for reasonable attorney fees of the garnishee, which he may then tax as additional court costs against the judgment debtor. An attorney MAY BE required.

DEBT CLAIM DEBT CLAIM CASE: A debt claim case is a lawsuit brought to recover a debt by an assignee of a claim, a debt collector or collection agency, a financial institution, or a person or entity primarily engaged in the business of lending money at interest. The claim can be for no more than $10,000, excluding statutory interest and court costs but including attorney fees, if any. IMPORTANT NOTICE: APROPRIATE COURTROOM ATTIRE IS REQUIRED. All persons entering the courtroom should be dressed in clothing reasonable befitting the dignity and solemnity of the court proceedings. No shorts, tank tops, flip flops, hats, etc. Cell phones and other electronics must be turned off when in the courtroom. Food and drink is not allowed in the courtroom.

READ CAREFULLY BEFORE FILING PETITION FOR INFORMATION ON THE RULES OF PRACTICE IN JUSTICE COURTS, PLEASE CONSULT PART V OF THE TEXAS RULES OF CIVIL PROCEDURE, WHICH IS AVAILABLE ONLINE AND AT EACH COURT. THE FOLLOWING INFORMATION IS FURNISHED TO YOU AS A COURTESY OF THE JUSTICE OF THE PEACE OFFICE. THE COURT CANNOT ADVISE YOU WHAT YOU SHOULD DO AND ARE BARRED BY LAW FROM GIVING YOU LEGAL ADVICE. WE CAN ONLY ANSWER PROCEDURAL QUESTIONS. 1. CLAIM Please complete the Civil Information Sheet, Petition and Affidavit of Military Status of Defendant. PLEASE PRINT CLEARLY. You are the plaintiff and the person or entity you are suing is the defendant. Under complaint section, make a very short statement concerning the nature of your claim. Under relief section, put the PRINCIPAL AMOUNT of your claim against the defendant. DO NOT ADD COURT COSTS to this amount. If you wish to have the judgment include court costs, you would state plus court costs. The Additional Information, Interest and Assignment sections must also be completed. 2. VENUE The defendant has a right to be sued in the county and precinct in which they reside; there are exceptions to this rule. Should there be a motion by the defendant to transfer venue, a hearing will be set to determine if a transfer of venue will be granted; a motion to transfer venue may delay the proceedings 6-8 weeks. 3. DEFENDANT IT IS YOUR BURDEN AS PLAINTIFF TO MAKE SURE YOU ARE SUING THE DEFENDANT IN THEIR PROPER LEGAL CAPACITY. It is very important that you understand that for any potential judgment you may receive to be valid, it is necessary for you to sue the defendant in their proper legal capacity, of which there are typically three: a) Personally: Where an individual is responsible to you for damages he may have caused you as an individual. b) Proprietor or partnership: A business that is not incorporated, but does have on file with the County Clerk an assumed name, ex: John Smith dba Greenhouse Supplies. c) Corporation: The business which has allegedly caused you damage is incorporated and therefore it is necessary to know the individual s name who is authorized to accept civil process on behalf of the corporation. The authorized agent for service would be listed with the Secretary of State, whose phone number is 1-800-252-5555, website is www.sos.state.tx.us Ex: Greenhouse, Inc. through its agent, John Smith. It is also possible for an incorporated entity to have an assumed name, ex: Greenhouse, Inc. dba Greenhouse Supplies.

4. SERVICE OF CITATION After the petition is completed, you will then be required to pay the fees for filing the petition and service of citation. If the citation is to be served out of Stephens County, you will be required to pay the service fee in the form of a money order made payable to the out-of-county agency. Please check with the clerk for more information in that case. A citation along with a copy of your petition will be served to the defendant notifying him that a suit has been filed against him in this Court. The citation will order the defendant to file an answer with the court by the end of the 14 th day after the day he was served with the citation. 5. TRIAL PLEASE NOTE: YOU MUST HAVE COPIES FOR THE COURT S FILE OF ANY DOCUMENTS YOU INTEND TO SUBMIT TO THE COURT AS EVIDENCE; YOU WILL BE CHARGED FOR ANY COPIES THE COURT MUST MAKE. a) If the defendant has entered a denial, the case will be set for trial. The trial notice will be mailed approximately 45 days prior to the trial date, or b) If the defendant did not answer and a prove-up hearing will be set for you to present your facts to the Court as to why you should be granted a default judgment. Notice of the hearing will be mailed to you. 6. POST JUDGMENT REMEDIES If you should receive a judgment, please understand that this Court does not collect the judgment for you, nor can we force the defendant to pay the judgment. It is your responsibility to request any post-judgment remedies. The following are some of those remedies that are available to you: a) Abstract of Judgment places a lien on any real property the defendant may own in a particular county where the abstract is recorded. There is a fee of $5.00 for the Court to issue the abstract. You will also be required to pay a small fee to the County Clerk to record the abstract. This may be obtained 21 days after the judgment was signed. b) Writ of Execution authorizes the Constable or Sheriff to seize any assets belonging to the defendant that are not exempt under Texas Property Code, Section 42.001 and 42.002. Those assets are then auctioned at a public sale and those proceeds are applied to the judgment. This may be obtained thirty (30) days after the judgment was signed.

7. PLEASE REMEMBER a) It is not required but it is prudent to seek counsel from an attorney before filing any lawsuit. b) It is your duty to provide the correct address or location where service of citation may be obtained by the Constable. c) When filing a civil suit you are only making an allegation that you should recover from the defendant. There is no guarantee you will prevail at trial. d) You should assume that the defendant will contest your allegation and may file a counter suit against you. e) You should properly prepare your case for trial. f) Hearsay evidence is inadmissible. Examples of hearsay evidence are written affidavits, garage estimates, police reports, and what other people orally said. g) If witnesses are required you may subpoena them to court by requesting a subpoena and paying the required fee of $70 per person. h) After you present your case at the trial, the defendant will then have his time to present a defense to your claim and explain why you should not recover. i) Either party may appeal the case if the court rules against their claim. The appeal must be filed within twenty (20) days or the right to appeal is lost. j) If the case is not appealed, the judgment is final.

JUSTICE COURT CIVIL CASE INFORMATION SHEET (4/13) Cause Number (for clerk use only): Styled (e.g. John Smith V All American Insurance Co. In re Mary Ann Jones; In the Matter of the Estate of George Jackson) A civil case information sheet must be completed and submitted when an original petition is filed to initiate a new suit. The information should be the best available at the time of filing. This sheet, required by Rule of Civil Procedure 502, is intended to collect information that will be used for statistical purposes only. It neither replaces nor supplements the filings or service of pleading or other documents as required by law or rule. The sheet does not constitute a discovery request, response, or supplementation, and it is not admissible at trial. 1. Contact Information for person completing Case information sheet. Name: Phone #: Fax #: Address: City/State/Zip State Bar # Email: Signature: 2. Names of parties in this case: Plaintiff(s): Defendant(s): (Attach additional pages as necessary to list all parties) 3. Indicate case type, or identify the most important issue in the case (select only 1) Debt Claim: A debt claim case is a lawsuit brought to recover a debt by an assignee of a claim, a debt collector or collection agency, a financial institution, or a person or entity primarily engaged in the business of lending money at interest. The claim can be for no more than $10,000, excluding statutory interest and court costs but including attorney fees, if any. Repair and Remedy: A repair and remedy case is a lawsuit filed by a residential tenant under Chapter 92, Subchapter B of the Texas Property Code to enforce the landlord s duty to repair or remedy a condition materially affecting the physical health or safety of an ordinary tenant. The relief sought can be for no more than $10,000, excluding statutory interest and court costs but including attorney fees, if any. Eviction: An eviction case is a lawsuit brought to recover possession of real property, often by a landlord against a tenant. A claim for rent may be joined with an eviction case of the amount of rent due and unpaid is not more than $10,000, excluding statutory interest and court costs but including attorney fees, if any. Small Claims: A small claims case is a lawsuit brought for the recovery of money damages, civil penalties, personal property, or other relief allowed by law. The claim can be for no more than $10,000, excluding statutory interest and court costs but including attorney fees, if any.

CAUSE NO. IN THE JUSTICE COURT VS PRECINCT ONE STEPHENS COUNTY, TEXAS AFFIDAVIT OF MILITARY STATUS OF DEFENDANT Before me, the undersigned clerk of the justice court or notary public, on this day personally appeared the undersigned affiant whose identity is known to me. After I administered an oath to such affiant, he or she upon oath and under penalty of perjury stated the following: My name is [please print] ; I am [check one] the plaintiff or an authorized agent or attorney for the plaintiff in the above styled and numbered cause. I am over the age of 18 and am capable of making this affidavit. The facts stated in the affidavit are within my personal knowledge and are true and correct. [check as applicable] [ ] The defendant is not in the military. [ ] The defendant is not on active duty in the military and/or [ ] The defendant is not in a foreign country on military service. [ ] The defendant is on active military duty and/or is subject to the Service member Civil Relief Act of 2003. [ ] The defendant has waived his/her rights under the Service member Civil Relief Act of 2003. [ ] The defendant s military status is unknown at this time. Signature of Plaintiff/Agent/Attorney Subscribed and sworn to before me by on this the day of, 20. Court Clerk/Notary Public PENALTY FOR MAKING OR USING FALSE AFFIDAVIT: A person who makes or uses an affidavit knowing it to be false, shall be fined as provided in title 18 United States Code, or imprisoned for not more than one year, or both.

PLAINTIFF PETITION: DEBT CLAIM CASE CASE NO. Vs. In the Justice Court, Precinct One, Stephens Co., Texas DEFENDANT(S): Defendant(s) address: COMPLAINT: The basis for the claim which entitles the plaintiff to seek relief against the defendant is: Relief: Plaintiff seeks damages in the amount of $ SERVICE OF CITATION: Service is requested on defendants by personal service at home or work or by alternative service as allowed by the Rules of Practice in Justice Courts. Other addresses where the defendant(s) may be served are: ADDITIONAL INFORMATION (CASE BASED ON CREDIT CARD, REVOLVING ACCOUNT, OR OPEN ACCOUNT): Account/Credit Card Name: Account Number (may be masked): Date of Issue/Origination: Date of Charge-Off/Breach: Amount Owed $ as of ADDITIONAL INFORMATION (CASE BASED ON PROMISSORY NOTE OR OTHER PROMISE TO PAY PERSONAL OR BUSINESS LOAN): Date/Amount of Original Loan : $ Repayment Accelerated? Date Final Payment Due: Amount Due on Final Payment Date: $ Amount Due: $ as of ONGOING INTEREST: Plaintiff does, or does not seek ongoing interest. If so, this interest is based on the following contractual/statutory reason: and should be at %. $ of interest was due as of. ASSIGNMENT OF CLAIM: Plaintiff was, or was not assigned or otherwise transferred this claim. If so, the original and the date the case was assigned/transferred to plaintiff was, subsequent holders were, and the date the case was assigned/transferred to plaintiff was. If you wish to give your consent for the answer and any other motions or pleadings to be sent to your email address, please check this box, and provide your valid email address:. Plaintiff s Printed Name Address of Plaintiff s Attorney, if any, or Plaintiff if none Phone & Fax No. of Attorney, if any, or Plaintiff if none Signature of Plaintiff or Attorney City State, Zip DEFENDANT(S) INFORMATION (if known): DATE OF BIRTH: *LAST 3 NUMBERS OF DRIVER LICENSE: * LAST 3 NUMBERS OF SOCIAL SECURITY: DEFENDANT(S) PHONE NUMBER: