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MAGISTRATE COURT OF DOUGLAS COUNTY 8700 Hospital Drive Douglasville, Georgia 30134 Case Number: Date Filed: PLAINTIFF: VS PHONE EMAIL ADDRESS: STATEMENT OF CLAIM _____Suit on a Note _____Suit on Account _____Other/Explain Plaintiff says the defendant is indebted to the plaintiff as follows: That said claim is in the amount of plus cost to date; and all future cost of this suit. State of Georgia, Douglas County: being duly sworn on oath, says the forgoing is a just and true statement of the plaintiff and claim made by plaintiff against defendant, exclusive of all set-offs and just grounds of defense. Sworn and subscribed before me This day of Plaintiff/Agent Notary Public/Attesting Official/Deputy Clerk Title/Capacity NOTICE AND SUMMONS You are hereby notified that has made and filed a claim and is asking for judgment against you in the sum of dollars as shown by the foregoing statement. YOU ARE REQUIRED TO FILE OR PRESENT AN ANSWER TO THIS CLAIM WITHIN 30 DAYS AFTER SERVICES 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 CHIEF OR PRESIDING MAGISTRATE DURING REGULAR COURT HOURS. The court will hold 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, see the court at once for assistance. If you have any claim against the plaintiff, you should notify the court at once. If you admit the claim, but desire additional time to pay, you must come to the hearing in person and state the circumstances to the court. You may come with or without an attorney. Clerk, Douglas County