Illinois > Local County > Lake > Small Claims
Small Claims Complaint 171-32 - Illinois
| Small Claims Complaint Form. This is a Illinois form and can be used in Small Claims Lake Local County . |
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS ) ) ) PLAINTIFF) vs. ) Case Number :_____________ ) ) ) DEFENDANT) SMALL CLAIMS COMPLAINT 1. I ________________________, am the plaintiff. ( Type or print your first and last name in the blank space.) 2. The defendants name is __________________________________________________. (Type or print the defendants first and last name, or company name in the blank space.) 3. The defendant owes me exactly $______________. (Type or print in the blank the amount. This figure must be $5000 or less in order for you to use this Small Claims procedure). 4. The reason the defendant owes me this amount of money is because: (Select only ONE of the reasons listed below that describes the facts of your case.): S Defendant agreed in a written contract to pay me this money, but has not paid me, even though I have demanded payment. (You need to attach a copy of the written contract to this Complaint, or attach a sworn statement explaining why y ou are not able to attach a copy). Date(s) this happened: ____________. S Defendant wrongfully took, destroyed or damaged my personal property. Date(s) this happened: ___________. Describe what happened: _____________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ S Defendant verbally agreed to pay me this money, but has not paid me, even though I have demanded payment. Date(s) this happened: ____________. 171-32 Rev. 02/03 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 S Defendant agreed to do certain repair work for me but has not done it properly even though I paid for the work. Date(s) this happened: _____________. Describe what happened: _____________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ S The Defendant injured me. Date(s) this happened: ____________. Describe your Injury: ________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Describe what happened: _____________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ S Some other reason. (If none of the other reasons above apply, describe here why defendant owes you the money you claim) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Date(s) this happened: ___________. Date: ____________ _____________________________ P laintiffs Signature ===================================================================== PLAINTIFFS Address: DEFENDANTS Address: ____________________________ ___________________________ ____________________________ ___________________________ ____________________________ ___________________________ Phone: ______________________ Phone: _____________________ ARDC: _____________________ ARDC: _____________________ ===================================================================== 171-32 Rev. 02/03 American LegalNet, Inc. www.USCourtForms.com
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