Fillable NOTICE OF SMALL CLAIM (Stevens County)

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NOTICE OF SMALL CLAIM (Stevens County)

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U.S.A. forms for Stevens County

BROWSE STEVENS COUNTY (WA) FORMS

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IN THE
DISTRICT COURT OF STEVENS
COUNTY, WASHINGTON
PLAINTIFF’S NAME
SMALL CLAIM #
ADDRESS
NOTICE OF SMALL CLAIM
CITY STATE ZIP
HOME PHONE NO WORK PHONE NO.
VS.
DEFENDANT’S NAME DEFENDANT’S NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE NO. PHONE NO.
YOU ARE HEREBY NOTIFIED that the above named Plaintiff has filed a claim against you
amounting to $ ; the reasons for which are stated below on the
second page of this Notice.
YOU ARE HEREBY FURTHER NOTIFIED THAT a settlement/mediation conference has
been scheduled for you as follows at the below location. You are encouraged to utilize this
opportunity to resolve your case prior to attending court. The Fulcrum Institute Dispute
Resolution Clinic will contact you to confirm your appointment.
DATE: _______________________________ TIME: _______________________________
FULCRUM INSTITUTE DISPUTE RESOLUTION CLINIC
119 W. ASTOR
COLVILLE, WA 99114
PHONE: 509-684-8565 FAX: 509-684-5464
E-MAIL: colvillemediation@fulcrumdispute.com
IF YOU DO NOT REACH A SETTLEMENT at your mediation, you are to appear at Stevens
County District Court, 215 South Oak, Room 215, Colville, Washington on
DATE:____________________________________ TIME:__________ a.m./p.m. for TRIAL.
Notice of Small Claim - Page 1 of 2
MISC 05.0100 (6/2004) RCW 12.40.020, .050. .060, .070
Notice of Small Claim - Page 2 of 2
MISC 05.0100 (6/2004) RCW 12.40.020, .050. .060, .070
You are to bring with you any and all papers, contracts and proof needed by you to establish or
defend this claim. At the time of trial you must bring any witnesses who will testify on your
behalf.
YOU ARE FURTHER NOTIFIED that if you fail to personally appear as directed, a Judgment
may be entered against you for the amount claimed, plus Plaintiff’s costs of filing and service of
the claim upon you. Plaintiff must also appear if a Judgment is to be entered. If Plaintiff fails to
appear, the claim may be dismissed. If this claim is settled prior to the hearing date, the parties
must notify the Court immediately, in writing.
Clerk
Small Claim #
STATEMENT OF CLAIM
I, , the undersigned plaintiff, declare that the Defendant
named above owes me the sum of $ , which became due and owing on
[Date]
The amount owed is for:
Faulty Workmanship Merchandise Auto Damages-Date of Accident
Wages Loan Return of Deposit Rent Property Damage
Other
Explain reason for claim
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is
true and correct.
Signed at _______________________(city), ____________(st.), on this _______ day of
______________________, 20____.
Signature Print or Type Name
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NOTICE OF SMALL CLAIM (Stevens County)

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Completed 18 July 2020

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