MAKE YOUR FREE Small Claims Worksheet
What is a Small Claims Worksheet?
When to use a Small Claims Worksheet:
- Another party has caused you financial loss or otherwise owes you money and refuses to pay voluntarily.
Sample Small Claims Worksheet
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SMALL CLAIMS COURT WORKSHEET
Prepared on:
PLAINTIFF INFORMATION. The person who will be completing the forms used to file suit in small claims court will need to know some personal information about the person or party who is making the claim and bringing the lawsuit ("Plaintiff"), including name, address, and county of residence.
| Doing business as: |
DEFENDANT INFORMATION. The person who will be completing the forms used to file suit in small claims court will need to know some personal information about the party a claim is being made against ("Defendant"), including name, address, and county of residence.
| Doing business as: |
SMALL CLAIMS COURT SUITABILITY
| 1. | Settlement Attempts. |
| 2. | Demand. A "demand letter", or substitute method, was given to the Defendant on: . |
| 3. | Ability to Collect from the Defendant. The likelihood that the Defendant is able to pay the judgment amount, if obtained, is: |
| 4. | Statute of Limitation; Type of Claim. The incident/due date/breach of obligation which gave rise to the claim occurred on: . |
DAMAGES
| 1. | Damages. The amount of the claim is as follows: |
Personal Injury:
| Un-reimbursed medical bills |
| Loss of wages |
| Pain and suffering |
| Personal Injury Total |
| Total Damages: |
| 2. | Maximum: The maximum claim allowed in Small Claims Court in is $. |
LIABILITY
The Defendant is legally liable for the claim for the following reason(s):
oral contributed to the damages to the Plaintiff by: sold an oral warranty
| PROCEDURE |
| 1. | Where to File. The event which gave rise to this claim occurred in County, . |
The Defendant lives/operates a business in County, .
The claim should be filed in County, .
The Small Claims Court Clerk's office is located at:
| Street: |
| City: |
| Phone: |
| 2. | Obtain Forms. The Plaintiff should obtain the necessary forms from the court clerk, and take the appropriate steps, which may include: |
- Complaint: Pay filing fee.
- Verification of Account.
- Affidavit of Military Status.
- Witness subpoena. Pay fee of .
- Documents to attach.
- Service of process. Pay fee of .
- Other:
| 3. | Follow-Up |
Initial Response.
Plaintiff should contact the clerk to verify that:
- the Defendant received notice.
- the Defendant has not successfully opposed the scheduled hearing date.
- each involuntary witness has received a subpoena.
Introduction.
Defendant's liability is based on:
Plaintiff's non-liability is based on:
The claim for damages includes:
Requested to be allowed to present an oral argument (where allowed).
The Judgment Debtor has failed to pay the judgment within days after the due date.
Creditor has identified a bank where the Debtor owns one or more accounts:
Bank Account or Employer identified is located in a county other than where the judgment was entered.
Vehicle - describe: .
| Estimated public auction proceeds: |
| Minus estimated expenses of sale: |
| Minus debts against the asset: |
| Minus exempt amount: |
| Expected Recovery: |
Appliance - describe: .
| Estimated public auction proceeds: |
| Minus estimated expenses of sale: |
| Minus debts against the asset: |
| Minus exempt amount: |
| Expected Recovery: |
Other personal property - describe: .
| Estimated public auction proceeds: |
| Minus estimated expenses of sale: |
| Minus debts against the asset: |
| Minus exempt amount: |
| Expected Recovery: |
| Total Recovery: |
On , judgment in the amount of , plus interest at the rate of % per annum thereon from and after , and court costs in the amount of , was entered against the Debtor.
| . | All records relating to your assets and debts from the date of judgment to the present date. These should include: Deeds, contracts, bank records, stock and bond account records, liens, mortgages, notes, loans owed, loans given to others, vehicle titles and registrations, pension or profit-sharing accounts. |
