PARMA MUNICIPAL COURT, PARMA, OHIO STATEMENT OF …
[Pages:1]PARMA MUNICIPAL COURT, PARMA, OHIO STATEMENT OF CLAIM/SMALL CLAIMS COMPLAINT (440) 887-7400 Ext.7421 ________________________________________________________________________________________
Plaintiff________________________________________
Defendant__________________________________________
Address________________________________________ Street
Address___________________________________Apt.#_____ Street
________________________________________ City, State, Zip
____________________________________________ City, State, Zip
Telephone Number ______________________________ Required
Plaintiff________________________________________
Address________________________________________ Street
Telephone Number ___________________________________
Defendant__________________________________________
Address___________________________________Apt.#_____ Street
________________________________________ City, State, Zip
____________________________________________ City, State, Zip
Telephone Number ______________________________
Telephone Number ___________________________________
Required
Is the DEFENDANT presently in the military or naval service of the United States: _____YES _____NO
STATEMENT OF CLAIM __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
Amount Claimed $ ___________________________
Plus Court Costs $ ____________________________
STATE OF OHIO
) ss.
COUNTY OF CUYAHOGA )
AFFIDAVIT OF COMPLAINANT'S CLAIM
_______________________________________________________________, being first duly sworn, on oath states that they are the Plaintiff(s) in the above entitled cause; that the said cause is for payment of money that the nature of plaintiff's demand is as stated, and 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.
Plaintiff_________________________________________________
Subscribed and sworn to before me this ________day of _____________________________________________________, 20__________________
Clerk, Deputy Clerk, Notary Public ___________________________________________________ ________________________________________________________________________________________________________________________ Revised October 2019
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