WASHINGTON COUNTY SUPERIOR COURT — Frank Newkirk, JR., Judge
Phone: 812-883-4949 — Toll Free: 1-800-453-1978
Fax: 812-883-5488— E-Mail: superior@blueriver.net
Address: 801 Jackson St. (Hwy 60 East), Salem, IN 47167
Office Hours: Monday through Friday — 8:30 a.m. — 4:00 p.m.

SMALL CLAIM

STATEMENT OF CLAIM

Brief Statement of Claim:________________________________________________________________________________

DATE:___________________________

__________________________________
Signature of Plaintiff of Plaintiff's Attomey

NOTICE TO APPEAR

THE COURT HAS SET THIS CASE FOR HEARING ON THE _____ DAY OF_____________, 2___at ______M.
If the Plaintiff fails to appear for the hearing, the court may dismiss his claim.
If the Defendant fails to appear at the hearing, judgment by default may be entered against defendant(s).

__________________________________
Clerk, Washington Circuit/Superior Court

The Parties may appear either in person or by their attorney.

The Parties are hereby directed to bring to the hearing all documents and witnesses in their control or possession concerning this claim. The Clerk will issue subpoenas for witnesses upon their request

If you wish to admit the plaintiff's claim you may appear for the purpose of allowing the court to establish a method of payment.

If either party is unable to appear at the time set for hearing, he should contact the Court for a change of the hearing date (Superior Court 883-4949, Circuit Court 883-5302).

The Defendant must provide the court and the plaintiff with a written statement of any counterclaim arising out of the Plaintiff's claim at least seven (7) calendar days before the hearing.

The defendant may, not later than ten (10) days following service of the complaint, make demand for a trial by jury by affidavit stating that there are questions of fact requiring a trial by jury, and specifying the same and that such is intended in good faith.

NO PERSONAL CHECKS WILL BE ACCEPTED.

SHERIFF'S RETURN ON SERVICE

I hereby certify that I have served this Statement of Claim/Notice to appear on the ______ day of _____________, 20_____.

(1) By delivering a copy of the Statement of Claim to the Defendant,____________________________

_____________________________________________________________________________________.

(2) By leaving a copy of the Statement of Claim at __________________________________________

which is the dwelling place or usual place of abode of ________________________________________

(3) Other Service or Remarks ____________________________________________________________

__________________________________________
Sheriff

By: ___________________________________________
Deputy

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