HOW TO GET A MONEY JUDGMENT
IN SMALL CLAIMS COURT
Form DC 84
AFFIDAVIT AND CLAIM,
SMALL CLAIMS
Use this form if you want to bring a lawsuit against someone who owes you money or who has caused
damage to your property or possessions and you cannot resolve the dispute through mediation or other
means. If your damage is the result of an intentional wrongdoing, such as fraud, libel, slander, malicious
destruction of property, or assault and battery, you cannot bring your action in the small claims division
of the district court unless the wrongdoing is for a dishonored check, consumer protection violation, or
recreational trespass.
You cannot use the small claims division of the district court if:
1) your case is against the State of Michigan or a state agency,
2) your case is against a local governmental unit that involves issues of governmental immunity,
3) you are an assignee or third-party beneficiary of the obligation, or
4) you have filed more than five small claims cases in the same week.
The maximum you can collect through a judgment in the small claims division of the district court is $6,000.
If your claim is for more than $6,000, you can still use the small claims division but your judgment award
cannot exceed $6,000 and you permanently waive the right to collect the rest of your claim.
CLAIM CHECKLIST
Use the following checklist to make sure you have done all the steps that are needed.
DID YOU . . .
1. Fill out all requested information on the form? Yes
2. Make all necessary copies of the form? Yes
3. Filetheformandlingfeewiththeclerkofthecourt? Yes
4. Have the form served on the defendant? Yes
5. Keep one copy of the form for yourself? Yes
If you cannot answer “yes” to all the above steps, a trial on your claim may be delayed or
your claims may be dismissed.
By using this form packet you are representing yourself or an employer, a business, or
other organization in a small claims court action. In order to receive the action you seek,
you must follow the instructions in this packet. If you fail to do even one of the required
steps, the court may not be able to give you the result you want.
If you have questions about any step in the process, refer to pages 3 through 5 of this
booklet for details.
PAGE 2
INSTRUCTIONS FOR USING FORM DC 84
FILING AND SERVING A CLAIM
»» WHO CAN FILE A CLAIM
Anadavitandclaimcanbesignedandledbysomeoneotherthantheplainti.Theplainticanbe
yourself if you are suing as an individual or a sole proprietor (sole owner of a business). If you are not
the plainti, but you are ling the claim for a sole proprietorship (a business owned by one person),
corporation, or other organization, you must meet the following conditions:
Ifyouarelingforanindividualandyouarenotthatindividual,youmustbetheindividual's
guardian, conservator, or next friend.
Ifyouarelingforasoleproprietor(soleownerofabusiness)andyouarenottheowner,you
must be a full-time salaried employee of the sole proprietor and you must have knowledge of
the facts in the claim.
Ifyouarelingforapartnership,youmustbeoneofthepartnersoryoumustbeafull-time
salaried employee of the partnership and you must have knowledge of the facts in the claim.
Ifyouarelingforacorporation,youmustbeafull-timesalariedemployeeofthecorporation
and you must have knowledge of the facts in the claim.
Ifyouarelingforacounty,city,village,township,orlocalorintermediateschooldistrict,you
mustbeanelectedorappointedoceroremployeeofthecounty,city,village,township,or
local or intermediate school district who has knowledge of the facts surrounding the claim and
who is authorized by the governing body of the county, city, village, township, or local or
intermediateschooldistricttoletheclaim.
»» FILING A CLAIM
1. Can I have an attorney?
Ifyoudecidetoleaclaiminthesmallclaimsdivisionofthedistrictcourt,anattorneycannot
represent you. However, if the defendant wants an attorney, the defendant can demand that the
claim be removed to the general civil division of the district court.
2. What does it cost?
Thefeeforlingaclaiminthesmallclaimsdivisionofthedistrictcourtis:
$30fordamageclaimsupto$600($25lingfee+$5electroniclingsystemfee)
$50fordamageclaimsfrom$600to$1,750($45lingfee+$5electroniclingsystemfee)
$70fordamageclaimsover$1,750to$6,000($65lingfee+$5electroniclingsystemfee)
Theplaintiisresponsibleforpayingthelingfeeandotherfees.Ifthejudgerulesinfavorofthe
plainti,thesefeesmaybeaddedtothejudgmentamountagainstthedefendant.
3. Signing the adavit and claim under oath.
Theadavitandclaimformmustbesignedunderoathinfrontofanotarypublic(youcanndone
atabank)ortheclerkofthecourt.Thepersonsigningtheformmustshowphotoidenticationto
thenotarypublicorclerkofthecourtbeforesigningtheadavitandclaim.Theformcanonlybe
signedbythepersonwhocanleaclaim,asstatedabove,underWhoCanFileaClaim.
Beforeyoucompletetheform,youshoulddecidewhetheryouwanttosigntheadavitandclaim
infrontofanotarypublicorinfrontoftheclerkofthecourt.Ifyoudecidetosigntheadavitand
PAGE 3
claim in front of a notary public, you only need to print out one copy of the form after completing
it. You can make three additional copies afterward. If you go to the court in person, print all four
copies of the form after completing it.
4. Fill out the adavit and claim form.
FilloutformDC84(AdavitandClaim,SmallClaims)onthewebsiteorgetapapercopyofthe
formfromthecourttollout.Followtheinstructionsonpage6.AftercompletingformDC84,
print out the number of copies you need (see Step 3 on pages 3 and 4).
5. File the adavit and claim with the court and make arrangements for service.
Youcanletheadavitandclaimwiththecourtinpersonorbymail.Youmustpaythelingfees
atthesametimeyouletheadavitandclaim.Ifyoucan’taordtopaythelingfee,asktheclerk
ofthecourtforanAdavitandOrder,SuspensionofFees/Costs(formMC20,whichisnot
includedinthispacket)tollout.Servicefeescancostaslittleas$15forcertiedmailorasmuchas
$26 plus mileage for personal service for each defendant.
Whenthelingisreceived,theclerkwillrecordthelingoftheclaim,assignacasenumber,and
write the name of the district court judge or district court attorney magistrate assigned to the case
onallcopiesoftheadavitandclaimform.Theclerkwillcompletethenoticeofhearing.
Theclerkwillkeeptheoriginaloftheadavitandclaimforthecourtle,andwillmakearrangements
to serve one copy on each defendant as you have instructed and paid, either by personal delivery or
bycertiedmail,returnreceiptrequestedanddeliverabletotheaddresseeonly.Afterservingthe
claim, the clerk will return the remaining copy of the form to you.
Tolewiththecourtinperson,takeallfourcopiesoftheformthatyoumadeinStep4tothe
clerkofthecourtintheproperdistrictcourt(seeMCL600.8415fordetails).Bringyourphoto
identicationandyourpaymentforthelingfeewithyou.Signtheadavitandclaiminfrontofthe
clerk of the court.
Tolewiththecourtbymail,youneedtodecidehowyouwanttohavetheadavitandclaim
served on each defendant because you will need to include payment for service when you mail your
claimtothecourt.Contactthecourttondoutwhatitwillcost.Placeallfourcopiesofthesigned
andnotarizedadavitandclaimform,paymentforthelingfee,paymentforservice,andoneself
addressedpostage-paidenvelopeinanenvelopeaddressedtotheproperdistrictcourt(seeMCL
600.8415fordetails).Havethepostocemailthepackagetothecourt.
6. Filing proof of service with the court.
Aftertheadavitandclaimisservedonthedefendantbytheprocessserver,theprocessserver
willcompletetheproofofserviceandleitwiththecourt.Ifthecourtservestheadavitandclaim
bycertiedmail,theclerkofthecourtwillcompletetheproofofservice.
Iftheprocessserverisunabletoservetheadavitandclaimonadefendantbypersonalservice,
theprocessservermayservetheformbyoneoftheothermethodsstatedinMichiganCourtRule
2.105. It may be necessary for the court to reschedule the appearance date if it appears a
defendantwillnotreceivenoticeatleast7daysbeforetheappearancedate.SeeMCR4.303(C)
andMCL600.8406.
PAGE 4
7. Prepare for the trial.
Toprepareforthetrial,gathertheevidenceyouneedtoproveyourcase.Aletteroradavitfroma
witness will be accepted as evidence by the court without the witness being physically present at
the trial, but it is better if you have the witness come to court. If a witness is unwilling to appear, you
can ask the clerk of the court to issue an order to appear (subpoena), requiring the witness to
appear at the trial. The order to appear must be served on the witness (along with any witness fee)
no later than two days before the trial. You can pay the clerk of the court to make arrangements for
service of this order.
»» INFORMATION ABOUT ATTENDING THE HEARING
Bringyourcopyoftheadavitandclaimwithyoutothehearing.Also,bringwithyoualltheevidenceyou
gathered and witnesses who are willing to testify. If you received a written answer or counterclaim from
the defendant, bring that also. The trial will usually take place at the location stated in the notice to appear.
Itisimportantforyoutoarriveatthecourtontime.Ifyouleaclaimandarenotincourtwhenyourcase
is called, the case will probably be dismissed.
1.Youareexpectedtoconductyourselfinacourteousmannerandtofollowthecourt'sdirections.
2. Make a list of information you think is important for the district court judge or district court attorney
magistrate to know. You can use this list as a reminder to bring up the points you think are
important.
3. If you need someone to attend this hearing who is unwilling to attend, follow the procedure in
MichiganCourtRule2.506togetanordertoappear(subpoena)orconsultanattorney.
4. Go to the courtroom on the scheduled day and time. Dress neatly. Arrive 10 or 15 minutes early.
Bring your witnesses with you.
5. Go into the courtroom, take a seat, and wait for your case to be called. Do not interrupt any
hearing in progress.
6. The court clerk will call the case and you will appear before the district court judge or district
courtattorneymagistratetoproveyourcase.Witnesseswillbeallowedtotellthecourtaboutfacts
that support your evidence.
7.Whenyouarecalled,gotothefrontofthecourtroomandfollowthedirectionsofthedistrictcourtjudge
or district court attorney magistrate.
8.Aftermakingadecision,thecourtwillprepareanappropriatejudgmentandthedistrictcourtjudge
or district court attorney magistrate will instruct you about what to do next.
»» COLLECTING A MONEY JUDGMENT
If the court enters a money judgment in your favor and it is not paid when ordered, additional papers must
beledwiththecourttocollectonthejudgmentbyhavingwagesorabankaccountgarnishedorproperty
seized. This cannot occur until 21 days after the judgment is entered. The court may ask that information
be provided for these collection eorts. See http://courts.mi.gov/self-help/center/collect/pages/default.
aspx for details.
PAGE 5
INSTRUCTIONS FOR COMPLETING "AFFIDAVIT AND CLAIM, SMALL CLAIMS"
Please print neatly.
Items1through12mustbecompletedbeforeyourclaimcanbeledwiththecourt.Pleasereadtheinstructionforeachitem.
Thenllinthecorrectinformationforthatitemontheform.
 Writeinthenames,addresses,andtelephonenumbersoftheplaintiandthedefendant.Theplaintiisthe
 nameofthepersonsuingandmaybesomeoneotherthanyou.Iftheplaintiisabusiness,specifyboththe
legal name and any assumed name in which the business is being conducted. The defendant is the person
being sued. If you are suing a business, state its legal name if you know it. If you do not know its legal name,
state the name the business was using to conduct business. If there is more than one defendant, write the
words "et al." after the name of the defendant and write the additional names and addresses on a separate
sheet of paper.
Checktheboxthatistrue.Ifanothercivilcasewasledthatinvolvedtheplaintianddefendantregardingthe
sameproblemstatedinthisclaim,writethenameofthecourtwherethecasewasled,thecasenumber,and
thenameofthejudgeassignedtohearthatcase.Checktheboxwhetherthatcaseisorisnotstillpending.
 Apersonotherthantheplainticancompleteandsignthisform.Readpage3andthenchecktheboxthat
bestdescribesyourrelationshiptotheplainti.Ifyouaretheplainti,checkthebox"plainti."Ifyouarea
partner and you are suing for the partnership, check the box "a partner." If you are a full-time employee of
theplaintiandaresuingfortheplainti,checkthebox"afull-timeemployeeoftheplainti."
 Theplainticanbeeither:1)anindividual,2)apartnership,3)acorporation,4)asoleproprietor(aprivate
businessownerwithoutapartner),or5)anotherorganization.Checktheboxthatbestdescribestheplainti,
and if applicable, complete the blank for "other."
The defendant can be either: 1) an individual, 2) a partner in a business partnership, 3) a corporation, 4) a sole
proprietor(aprivatebusinessownerwithoutapartner),or5)anotherorganization.Checktheboxthatbest
describes the defendant, and if applicable, complete the blank for "other." If there is more than one defendant,
you will need to provide this information for each defendant.
Writeinthedatethatthedisputeoccurred.Forexample,ifthedefendantowedmoneyonacertaindateand
didnotpayonthatdate,printthatdatehere.Or,ifthedefendantdamagedsomethingthatbelongedtoyou,
print the date that the damage occurred.
Writeintheamountofthemoneyowedorthatyoubelieveisowedtocoveranydamageevenifitismorethan
$6,000. If the amount is more than $6,000 and the case is decided in the small claims division of the district
court,theplaintigivesuptherighttoanyamountover$6,000.Theplainticannotleanotherformtogeta
judgmentforthebalance.Iftheplaintiwantsajudgmentforanamountover$6,000andtheclaimisfor
$25,000orless,alawsuitmustbeledinthecivildivisionofthedistrictcourt.
 Brieyexplainthereasonsfortheclaim.Includewhathappenedtocausethedispute.
Make sure that you understand and agree with this statement.
Checktheboxesthataremostaccurate.
Checktheboxthatismostaccurate.
DO NOT SIGN YOUR NAME until you are standing in front of a notary or the clerk of the court.
DO NOT WRITE IN THE SECTION AFTER ITEM 12. The notary public or clerk of the court will complete this section.
Fileyouradavitandclaimwiththecourt.Theclerkofthecourtwillentertheexpirationdateandcompletethenotice of
hearing. See page 4 of this packet for details.
• Readpages3through5ofthisbookletfordetailsonlingandservingthisform.
You must read this booklet for directions on the legal process.
PAGE 6
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11
Approved, SCAO
Court telephone no.Court address
STATE OF MICHIGAN
JUDICIAL DISTRICT
AFFIDAVIT AND CLAIM
Small Claims
CASE NO.
DC 84 (12/17) AFFIDAVIT AND CLAIM, Small Claims MCL 600.8401 et seq., MCR 4.302, MCR 4.303, 50 USC App 521
2nd copy - Plainti (with instructions)
3rd copy - Return (with proof of service)
Original - Court (with instructions)
1st copy - Defendant (with instructions)
See additional notice and instructions on the back of plainti and defendant copies.
1.
Plainti
Address
City,state,zipTelephoneno.
2.
Defendant
Address
City,state,zipTelephoneno.
3. A civil action between these parties or other parties arising out of the transaction or occurrence alleged in this complaint
hasbeenpreviouslyledin this court
Court.
It was given case number
and assigned to Judge
.
The action remains is no longer pending.
4.IhaveknowledgeorbeliefaboutallthefactsstatedinthisadavitandIam
theplaintiorhis/herguardian,conservator,ornextfriend. a partner. afull-timeemployeeoftheplainti.
5.Theplaintiis  an individual. a partnership. a corporation. a sole proprietor.
.
6. The defendant is an individual. a partnership. a corporation. a sole proprietor.
.
7.Thedate(s)theclaimaroseis/are
Attach separate sheets if necessary
.
8.Amountofmoneyclaimedis$
. (Note:Plainti’scostsaredeterminedbythecourtandawardedasappropriate.
They are not part of the amount claimed.)
9. The reasons for the claim are:
10.Theplaintiunderstandsandacceptsthattheclaimislimitedto$6,000bylawandthattheplaintigivesuptherightsto
(a)recovermorethanthislimit,(b)anattorney,(c)ajurytrial,and(d)appealthejudge’sdecision.
11. I believe the defendant is is not mentally competent. I believe the defendant is isnot 18yearsorolder.
12. I do not know whether the defendant is in the military service. The defendant is not in the military service.
The defendant is in the military service.
Signature
Subscribed and sworn to before me on
,
County,Michigan.
My commission expires:
Date
Signature:
Deputyclerk/Notarypublic
Notarypublic,StateofMichigan,Countyof
The defendant(s) must be served by
Expiration date
.
NOTICE OF HEARING
For Court Use Only
Theplaintiandthedefendantmustbeincourton
Day
Date
at
Time
at the court address above.
Location
.
Processserversname
Fee paid: $
/s/
AFFIDAVIT AND CLAIM
Small Claims
CaseNo.
TOPROCESSSERVER:Youaretoservethisadavitandclaimnolaterthan7daysbeforethehearingdate.Youmustmake
andleyourreturnwiththecourtclerk.Ifyouareunabletocompleteservice,youmustreturnthisoriginalandallcopiestothe
court clerk.
OFFICER CERTIFICATE
IcertifythatIamasheri,deputysheri,baili,or
appointedcourtocer(MCR2.104[A][2]),and
that: (notarization not required)
OR
AFFIDAVIT OF PROCESS SERVER
Beingrstdulysworn,IstatethatIamalegallycompetent
adultwhoisnotapartyoranocerofacorporateparty,
and that: (notarization required)
Iservedpersonallyacopyoftheadavitandclaim,
Iservedbyregisteredorcertiedmail(copyofreturnreceiptattached)acopyoftheadavitandclaim.
together with
Attachment
, on the defendant(s):
Defendant name Completeaddressofservice Day, date, time
Defendant name Completeaddressofservice Day, date, time
Defendant name Completeaddressofservice Day, date, time
Ihavepersonallyattemptedtoservetheadavitandclaim,togetherwithanyattachmentsonthefollowingdefendant(s)and
have been unable to complete service.
Defendant name Completeaddressofservice Day, date, time
Defendant name Completeaddressofservice Day, date, time
Defendant name Completeaddressofservice Day, date, time
I declare that the statements above are true to the best of my information, knowledge, and belief.
Service fee
$
Miles traveled Fee
Signature
$
Incorrect address fee
$
Miles traveled Fee TOTALFEE
$
Name (type or print)
$
Title
Subscribed and sworn to before me on
Date
,
County,Michigan.
My commission expires:
Date
Signature:
Deputycourtclerk/Notarypublic
Notarypublic,StateofMichigan,Countyof
IacknowledgethatIhavereceivedserviceoftheadavitandclaim,togetherwith
Attachment
on
Day, date, time
Signature
on behalf of
PROOF OF SERVICE
CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE
ACKNOWLEDGMENT OF SERVICE
MCR2.105
ADDITIONAL NOTICE AND INSTRUCTIONS
TO BOTH THE PLAINTIFF AND THE DEFENDANT:
You must bring to the hearing all witnesses, books, papers, and other physical evidence needed to prove or disprove this
claim.
Before the trial (hearing) starts, you have the right to
1. remove the case to the general civil division of the district court, or
2. have the case heard by a district court judge (if the hearing is scheduled before an attorney magistrate). If the case is
heard by an attorney magistrate, you may appeal to the district judge within 7 days after the trial.
• Ifthecaseistriedinthesmallclaimsdivision,yougiveuptherighttoanattorney,toajurytrial,andtoappealthejudge's
decision.
If you require special accommodations to use the court because of a disability or if you require a foreign language interpreter to
help you fully participate in court proceedings, please contact the court immediately to make arrangements.
TO THE DEFENDANT:
The affidavit and claim you have just received means you are being sued in the small claims division of the district court.
The court is being asked to decide a matter that the plaintiff says is your obligation and responsibility.
If you wish to deny this claim or arrange terms of payment, you must make your request by appearing at the date, time, and
place stated in the notice of hearing on the front of this form.
If you do not appear at the date, time, and place stated, a default judgment may be entered against you for the amount stated
initem8,includingthecostsofthisaction.
• Ifthedisputeissettledbeforeoratthehearing,youmayhavetopaytheplaintiff'scosts.
• Incaseajudgmentisenteredagainstyouatthehearing,youshouldbepreparedtopaytheamountstatedinitem8,
including the costs of this action, or to make arrangements for installment payments.