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IN THE MAGISTRATE COURT OF WALTON COUNTY, STATE OF GEORGIA 303 South Hammond Drive Suite 116 CIVIL ACTION Monroe, Georgia 30655 STATEMENT OF CLAIM [PHONE REDACTED] Date Filed Case VS Plaintiff Name Defendant Name/Date of Birth Address Address City, State, Zip Code City, State, Zip Code (Area Code) Phone number (Area Code) Phone number Court use only – date/time stamp filed Suit on Note Suit on Account ) The above named Defendant(s) is/are subject to the jurisdiction of this Court and indebted to the Plaintiff as follows: PLAINTIFF demands JUDGMENT against the Defendant in the amount of (EXCLUDES COURT COSTS): PLAINTIFF demands COURT COSTS against the Defendant in the amount of : PLAINTIFF demands ATTORNEY’S FEES against the Defendant in the amount of: PLAINTIFF demands PRE FILING INTEREST against the Defendant in the amount of: STATE OF GEORGIA, WALTON COUNTY: being duly sworn/affirm on oath, says the foregoing is a just and true statement of the Plaintiff and claim made by the Plaintiff against the Defendant, exclusive of all set-offs and just grounds of defense. Plaintiff or Agent or Attorney If Agent (title) SUMMONS TO ALL DEFENDANT(s): You are hereby notified that the above named Plaintiff(s) has/have made a claim and is requesting judgment against you in the sum of YOU ARE REQUIRED TO FILE or PRESENT AN ANSWER TO THIS CLAIM WITHIN (30) DAYS AFTER SERVICE OF THIS SUMMONS UPON YOU, exclusive of the day of service. If you fail to file an answer with this Court, Judgment by Default will be taken against you for the relief demanded in the complaint. Your answer may be FILED IN WRITING OR GIVEN ORALLY TO THE JUDGE. IF YOU CHOOSE TO FILE YOUR ANSWER ORALLY, IT MUST BE IN OPEN COURT IN PERSON WITHIN THE (30) DAY PERIOD. NO TELEPHONE ANSWERS ARE PERMITTED. If you have witnesses, books, receipts, or other writings bearing on this claim, you should bring them with you on the scheduled date and time of your hearing. If you require a witness(s) to be summoned, see the Court at once for assistance. If you have any claim(s) against the Plaintiff, notify the Court immediately. If you admit the claim, but desire additional time to pay, you must appear in Court on the scheduled date and time of your hearing and state those circumstances to the Court. You may proceed in this matter with or without representation of counsel/attorney. The Court will schedule a hearing upon this claim at the Walton County Magistrate Court at a date and time to be set after your answer if filed with the Court. NO LEGAL ADVICE WILL BE PROVIDED BY ANY MAGISTRATE COURT EMPLOYEE AT ANY TIME! FORMS RELATING TO YOUR CASE CAN BE OBTAINED IN THE CIVIL DIVISION OF THE MAGISTRATE COURT DURING REGULAR BUSINESS HOURS. Regular business hours are Monday through Friday, 8:30am – 5:00pm. Closed during observed Holidays and Saturday/Sunday. Magistrate Judge/Clerk/Deputy Clerk, Walton County Revised 01-06-2016 Sworn to and subscribed before me this of Notary Public/Attesting Official