IN THE CIRCUIT COURT OF THE STATE OF OREGON
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Small Claims Department |
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Case No: ____________________ |
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Plaintiff |
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(Inmate ID #, if applicable, _____________) |
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v. |
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SMALL CLAIM AND |
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) NOTICE OF SMALL CLAIM |
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Filing fee at ORS 46.570 |
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Defendant |
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Interpreter needed: Spanish Russian |
Defendant is a public body |
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other: _______________ |
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PLAINTIFF (
Additional on attached page)
Name
Street
City / State / Zip
DEFENDANT (
Additional on attached page)
Name (enter Registered Agent, if necessary, on next page)
Street (do not use a P.O. Box)
City / State / Zip
I, Plaintiff, claim that on or about (date) |
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sum of $_____________ because |
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, and this amount is still due.
I have paid (or will pay):
filing fees of $_____________
and service costs of $____________
Claim $______________
+Fees $______________
+Costs $______________
TOTAL $______________
Form 15.010.1a – SMALL CLAIM AND NOTICE OF SMALL CLAIM – UTCR 15.010(1)(a) |
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(Revised 8-1-14) |
Case No. |
DECLARATION OF BONA FIDE EFFORT
I, Plaintiff, have made a bona fide effort to collect this claim from the defendants before filing this claim
with the court clerk.
I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are made for use in court and I am subject to penalty for perjury.
Date |
Plaintiff Signature |
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Email address* |
Plaintiff Name (print) |
*Some courts communicate with parties by email. By providing my email address I consent to receive notifications from the court by email instead of or in addition to other methods. I understand that if my email changes or if I choose to withdraw consent, I must notify the court in writing.
DEFENDANT’S REGISTERED AGENT:
Name
Street (do not use a P.O. Box)
City / State / Zip
Form 15.010.1a – SMALL CLAIM AND NOTICE OF SMALL CLAIM – UTCR 15.010(1)(a) |
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(Revised 8-1-14) |
Case No. |
NOTICE TO DEFENDANT:
READ THESE PAPERS CAREFULLY!
Within 14 DAYS* after receiving this notice you MUST do ONE of the following things in
writing:
Pay the claim plus filing fees and service expenses paid by plaintiff (send payment directly to the plaintiff, not to the court) OR
Demand a hearing and pay the fee required (below) OR
Demand a jury trial and pay the fee required (below). This option is available only if amount claimed is more than $750.
If you fail to do one of the above within 14 DAYS* after you get this notice, the plaintiff may ask the court to enter a judgment against you. The judgment will be for the amount of the claim, plus filing fees and service costs paid by the plaintiff, plus a prevailing party fee. If you are not able to respond in time because you are in active military service of the United States, talk to a legal advisor about the Servicemembers Civil Relief Act.
COURT NAME / ADDRESS / PHONE #
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Defendant’s Filing Fees (must be filled in by the PLAINTIFF):
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To demand a hearing if the amount claimed is $2,500 or less |
$ ______ |
(2) |
To demand a hearing if the amount claimed is more than $2,500 |
$ ______ |
(3) |
To demand a jury trial (only if amount claimed is over $750) |
$ ______ |
If you have questions about filing procedures, go to www.courts.oregon.gov for information and instructions, or you may contact the court clerk. The clerk cannot give you legal advice about the claim.
*NOTE: If the plaintiff is an inmate (ORS 30.642) AND the defendant is a government agency or other public body (ORS 30.260), the defendant must respond within 30 days after receiving this Notice.
Form 15.010.1a – SMALL CLAIM AND NOTICE OF SMALL CLAIM – UTCR 15.010(1)(a) |
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(Revised 8-1-14) |
Case No. |