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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