Illinois > Local County > Winnebago > Small Claims
Small Claim Complaint CC-10 - Illinois
| Small Claim Complaint Form. This is a Illinois form and can be used in Small Claims Winnebago Local County . |
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STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT COUNTY OF WINNEBAGO FILE STAMP CC-10 V2 __________________________________ Plaintiff vs. Case No. ____________________ _________________________________ Defendant SMALL CLAIM COMPLAINT I, the undersigned, claim that the defendant is indebted to the plaintiff in the sum of $ _________________________ for__________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ and that the plaintiff has demanded payment of said sum; that the defendant refused to pay the same and no part thereof has been paid; that the defendant resides at ____________________________________________________________________ ____________________________________________________________________________________________________ Phone No. ______________________________; that the plaintiff resides at ______________________________________ ____________________________________________________________________________________________________ Phone No. ______________________________; in the State of Illinois. ___________________________, 20 ______ _____________________________________ (Signature of Plaintiff) Name ________________________________ Attorney for ___________________________ Address ______________________________ City _________________________________ Telephone ____________________________ AFFIDAVIT ____________________________________________, on oath and under penalty of perjury pursuant to Section 1-109 of the Illinois Code of Civil procedure, states that the allegations in this complaint are true. _____________________________ Date ________________________________________ Plaintiff If you have a disability that requires an accommodation to participate in Court, please contact the Court Disability Coordinator at 815-319-4806. CF6/12 American LegalNet, Inc. www.FormsWorkFlow.com
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