Magistrate Court of Banks County

MAGISTRATE COURT OF BANKS COUNTY STATE OF GEORGIA 144 YONAH-HOMER ROAD; SUITE 10 Case No. ______HOMER, GA 30547 Filing Date______STATEMENT OF CLAIM

PLAINTIFF (Name & Address) DEFENDANT (Name & Address) ______vs. ______Phone No.______Phone No.______

[ ] Suit on Note [ ] Suit on Account [ ] Other ______

1) The Court has jurisdiction over the defendant [ ] the Defendant is a resident of Banks County; [ ] Other (please specify) ______2) Plaintiff claims the Defendant is indebted to the Plaintiff as follows: (You may consider attaching contracts, invoices & other items to prove prima facie case.) ______

___3) That said claim is in the amount of: $______principal, $______interest, plus $______costs to date, and all future costs of this suit. State of Georgia, ______County: ______being duly sworn on oath says the foregoing is a just and true statement of the amount owing by defendant to plaintiff, exclusive of all set-offs and just grounds of defense. Sworn and subscribed before me this ______day of ______, 20______. ______Plaintiff or Agent ______Notary Public / Attesting Official (If Agent – Title or Capacity)

NOTICE AND SUMMONS TO: DEFENDANT You are hereby notified that the above named Plaintiff(s) has/have made a claim and is requesting judgment against you in the sum shown by the foregoing statement. YOU ARE REQUIRED TO FILE OR PRESENT AN ANSWER TO THIS CLAIM WITHIN 30 DAYS AFTER SERVICE OF THIS CLAIM UPON YOU. IF YOU DO NOT ANSWER, JUDGMENT BY DEFAULT WILL BE ENTERED AGAINST YOU. YOUR ANSWER MAY BE FILED IN WRITING OR MAY BE GIVEN ORALLY TO THE JUDGE DURING REGULAR COURT HOURS. The court will hold a hearing upon this claim at a time to be set after your answer is filed. If you have witnesses, books, receipts, or other writings bearing on this claim, you should bring them with you at the time of the hearing. If you wish to have witnesses summoned contact the court for assistance. If you have a claim against the Plaintiff, you should notify the court by filing a written answer and counterclaim. If you admit the Plaintiff’s claim but need additional time to pay, you must come to the hearing in person and tell the circumstances to the court.

This ______day of ______, 20____. ______Magistrate or Clerk of Court