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IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF (State of Alaska)

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Page 1 of 3
CIV-480 (4/19)(cs)
COMPLAINT TO COLLECT A DEBT
IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA
AT
(City or town where the court is located)
)
)
Plaintiff, )
v. )
)
) Case No.
Defendant. )
)
COMPLAINT TO COLLECT A DEBT
I, , state that the following facts are true and request
the following relief:
1. Filing Location. This is the correct court location to file in because:
(Check all that apply.)
Defendant is a resident of this judicial district.
Defendant is doing business in this judicial district.
The contract was created in this judicial district.
I am a resident in this judicial district.
2. Filing Court. I am filing this in the:
District Court because my claim is for $100,000 or less.
Superior Court because my claim is for greater than $100,000.
NOTE:
If your claims is for $10,000 or less you may file your action in Small Claims Court and
use informal procedures using a small claims complaint available here:
https://public.courts.alaska.gov/web/forms/docs/sc-1.pdf. For more information on small claims
procedure, go here: https://public.courts.alaska.gov/web/forms/docs/sc-95.pdf or here:
http://courts.alaska.gov/shc/debt/start-case.htm#file.
3. Contract or Agreement: I made the following contract or agreement with the
Defendant:
(Describe what each was supposed to do and the date you both made agreement.)
Page 2 of 3
CIV-480 (4/19)(cs)
COMPLAINT TO COLLECT A DEBT
More pages are attached.
4. Broken Contract or Agreement: The Defendant broke the agreement as follows:
(Explain how the Defendant broke the agreement and what the Defendant owes you.)
More pages are attached.
Page 3 of 3
CIV-480 (4/19)(cs)
COMPLAINT TO COLLECT A DEBT
REQUEST FOR RELIEF
I request that the court:
1. Order the Defendant to pay me $ .
2. Order the Defendant to pay %
1
interest, with interest starting on the
following date: .
3. Order the Defendant to pay my legal costs and any attorney fees.
4. Schedule the following trial:
A bench trial because I want the judge to hear the evidence and decide this case.
A jury trial because I want a jury to hear the evidence and decide this case. (
If you
want a jury trial, you must file a separate written document with this Complaint, or within 10
days of filing this Complaint, that tells the court you want a jury trial.)
5. Other:
6. Order any other relief the Court finds fit and proper.
I have included the following documents with this
Complaint
:
A copy of our contract or agreement.
Summons
, CIV-100 (Anchorage, Fairbanks, Kenai, Palmer, All other locations)--REQUIRED
Case Description Form--REQUIRED
CIV-125D (For filing in District Court)
CIV-125S (For filing in Superior Court)
Other documents that support this
Complaint:
Print Name Signature Date
Mailing Address City State ZIP
Phone Email*
* I authorize the court to email me court documents in this case to the email address above.
Need help? See Alaska Court System’s Self-Help Services Debt Collection Page at:
http://courts.alaska.gov/shc/debt/start-case.htm
1
For help determining interest rates: https://public.courts.alaska.gov/web/forms/docs/adm-505.pdf
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IN THE DISTRICTSUPERIOR COURT FOR THE STATE OF (State of Alaska)

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Completed 3 March 2022

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