Small Claims Information Sheet

SMALL CLAIMS DOCKET IN MAGISTRATE COURT, COUNTY OF , SD SCM# Default Hearing: Reset Default Hearing: Court Trial: Reset Court Trial: Fees Paid: $ Sheriff/Personal Service requested ­ certified mail returned unclaimed ­ returned refused Plaintiff 1: Address: City: Phone: Attorney & Address: Plaintiff 2: Address: City: Phone: Attorney & Address: Cell: State: Zip: Work: Cell: State: Zip: Work: Defendant 1: Address: City: Phone: Attorney & Address: Defendant 2: Address: City: Phone: Attorney & Address: Cell: State: Zip: Work: Cell: State: Zip: Work: Certified Mail Service: Sheriff/Personal Service: Court Remarks: Date Claim Dismissed: Judgment in favor of: Date of Judgment: Mailed: Authorized: Returned: Returned: Delivered: Served: With Prejudice Plaintiff Amount: $ X Defendant Interest: $ Without Prejudice Signature: Costs: $ Total: $ Clerk-Magistrate or Magistrate Judge By: Date Judgment Satisfied: Plaintiff's Claim: 6/2012 American LegalNet, Inc. www.FormsWorkFlow.com Principal Interest Sub Total Filing Fees Plaintiff's Total Service Fees Total $ $ $ $ $ $ $ Date: X Additional Costs (Service Fees ­ it is the responsibility of the plaintiff to file the Return of Service) Signature of Plaintiff Plaintiff's Affidavit of Defendant's Non-Military Status: I, being first duly sworn on my oath, depose and state: 1. I am over the age of eighteen years and am competent to make this affidavit. 2. I am the plaintiff or plaintiff's agent in the above-entitled matter. 3. That I have either made a personal investigation or personally reviewed the business records of the defendant. 4. As a result of the investigation or review: It is my belief that the above-named defendant is not in the military services on active duty; It is my belief that the above-named defendant is in the military service on active duty; I have been unable to determine whether or not the defendant is in the military service on active duty. My information and belief is based on the following: I understand that any false statements in this document are made under perjury, and that making a false statement is a violation of Federal Law and is subject to both fine and imprisonment. Dated this day of , __________________________________________________________________ Signature Subscribed and sworn to before me this _______ day of _______________, ________ __________________________________________________________________ Deputy Clerk or Notary Public If Notary, my commission expires: ______________________ (SEAL) Defendant's Answer/Denial: Filed on Counterclaim Interest Filing Fees Defendant's Total Date: X $ $ $ $ Additional Costs Service Fees ­ it is the responsibility of the defendant to file the Return of Service Signature of Defendant 6/2012 American LegalNet, Inc. www.FormsWorkFlow.com