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Complaint (Small Claim Commercial Claim Consumer Transaction) DC-283 - New York
| Complaint (Small Claim Commercial Claim Consumer Transaction) Form. This is a New York form and can be used in General Suffolk Local County . |
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SUFFO LK COUNTY DISTRI CT COURT COURT DATE INDEX NO. COMPLAINT FORM TIME & DISTRICT DATE MAILEDTHIS FORM MUST BE TYPED OR PRINTED: CHECK ONE TYPE OF CLAIM: SMALL CLAIM COMMERCIAL CLAIM CONSUMER TRANSACTION CHECK ONE SESSION: DAY COURT NIGHT COURT PLAINTIFF S NAME AND ADDRESS DEFENDANTS NAME AND ADDRESS If plaintiff is a business you must enter your true business name. If defendant is a business you must enter its true business name. Last Name, First Name or True Business Name Last Name, First Name or True Business Name Street Address (NO P.O. Boxes) Street Address (NO P.O. Boxes) City, State, ZIP City, State, ZIP Telephone Number: Telephone Number: Additional Plaintiff Additional Defendant Additional Plaintiff Additional Defendant Last Name, First Name or True Business Name Last Name, First Name or True Business Name Street Address (NO P.O. Boxes) Street Address (NO P.O. Boxes) City, State, ZIP City, State, ZIP Telephone Number: Telephone Number: If you need to list more than four parties, submit additional pages as needed, and check here:CHECK ONE CAUSE OF ACTION: (5) PERSONAL INJURIES (40) MONIES DUE (10) PROPERTY DAMAGE (50) PAYMENT OF LOAN (15) LOSS OF PERSONAL PROPERTY (70) REFUND ON DEFECTIVE MERCHANDISE (20) GOODS SOLD AND DELIVERED (80) REFUND ON DEFENDANTS DEFECTIVE WORK, LABOR AND/OR SERVICES (25) BREACH OF CONTRACT OR WARRANTY (35) WORK, LABOR AND SERVICES (85) OTHER CAUSE OF ACTION AS DETAILED BELOW STATE DETAILS OF YOUR CLAIM: TOTAL AMOUNT OF DAMAGES: The undersigned acknowledges that he/she has been advised that supporting witnesses, account books, receipts and other documents required to establish the claim herein must be produced at the hearing. The undersigned further certifies to the best of his/her knowledge, the defendant is not in the military service. If this is a complaint filed as a Commercial Claim (UDCA 1803-A) , the undersigned hereby certifies that no more than five (5) actions or proceedings (including the instant action) pursuant to the commercial claims procedure have been initiated in the co urts of this state during the present calendar month. THIS FORM MUST BE SIGNED IN THE PRESENCE OF A COURT CLERK OR NOTARY DATED: PLAINTIFF AS AUTHORIZED AGENT OF PLAINTIFF CLERK OR NOTARY AS PARENT AND NATURAL GUARDIAN DC-283 (10/03) American LegalNet, Inc. www.USCourtForms.com
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