CAUSE NO. ___________________________
____________________________________________________________Plaintiff § IN THE JUSTICE COURT
VS. § PRECINCT ___ PLACE ___
____________________________________________________________Defendant(s) § BRAZOS COUNTY, TEXAS
SWORN PETITION FOR A DEBT CLAIM LAWSUIT
I hereby state that I am filing a Debt Claim lawsuit: A Debt Claim case is a lawsuit brought to recover a debt by an assignee of a claim, a debt
collector or collection agency, a financial institution, or a person or entity primarily engaged in the business of lending money at interest. The
claim can be for no more than $10,000.00, excluding statutory interest and court costs but including attorney fees, if any.
I, PLAINTIFF: ________________________________________________________________________________________________dba under
FIRM:_____________________________________________________________________________(individually, partnership, or corporation)
Whose address is:_______________________________________________________________________________________(street, city, ZIP).
Phone numbers :( home), _________________________(business),_______________________ (cell)_________________________________;
HEREINAFTER called Plaintiff, being duly sworn, on my oath say that:
DEFENDANT: ________________________________________________________________________________________________________
Whose address is: ______________________________________________________________________________________ (street, city, ZIP).
Employed by: __________________________________________________________________________________________ (street, city, ZIP)
Phone numbers: (home), ________________________ (business),_______________________(cell)__________________________________.
IS JUSTLY INDEBTED TO THE PLAINTIFF IN THE SUM OF:$ ___________ . ____ plus Court Costs.
CREDIT ACCOUNTS: Account Name or Credit Card Name: _______________________________ Account No. _________________________
Date of Issue or Origination of Account: _________________________ Date of Charge-off or Breach of Account: _____________________
PERSONAL/BUSINESS LOAN: Date & Original Loan Amount: _______________________ Repayment Accelerated: _____________________
Final payment of $ ________________________ Due Date:________________________ Effective Interest Rate: ____________________ %
ASSIGNED DEBT: Debt Claim Assigned or Transferred To: ____________________________________ Date: __________________________
Amount Owed as of Certain Date: ______________________________ Ongoing Interest: YES or NO. Amount: ________________________
□SERVICE OF CITATION: Service is requested on Defendant(s) by personal service at home or work or by alternative service as allowed by the
Texas Justice Court Rules of Court. Other service of papers address/addresses (if knows) are:
____________________________________________________________________________________________________________________
REQUEST FOR JUDGMENT: Plaintiff prays that Defendant(s) be served with citation and that Plaintiff have judgment against Defendant(s) for:
the amount or items above, attorney’s fees, court costs, and interest on the above sums at the statutory rate for judgments.
□ I consent for
the answer and any other motions or pleadings to be sent to my email address which is: _________________________________________.
Date signed:_______________________________ ____________________________________________________
DEFENDANT(S) INFORMATION (if known): Plaintiff’s Signature
DATE OF BIRTH:_________________________________
*LAST 3 NUMBERS OF DRIVER LICENSE:______________
*LAST 3 NUMBERS OF SOCIAL SECURITY:_____________
DEFENDANT’S PHONE NUMBER:____________________
Sworn to and subscribed before me this ____ day of ________________, 20___. ________________________________________________
JP Debt Claim Petition. Rev.08/2013 CLERK OF THE JUSTICE COURT OR NOTARY
