INSTRUCTIONS FOR COMPLETING “AFFIDAVIT AND CLAIM, SMALL CLAIMS”
Please print neatly. MichiganLegalHelp.org has tools that can help you complete this form.
Items 1 through 12 must be completed before your claim can be led with the court. Please read the instruction for each item.
Then ll in the correct information for that item on the form.
1
2
Write in the names, addresses, and telephone numbers of the plaintiff and the defendant. The plaintiff is the
name of the person suing and may be someone other than you. If the plaintiff is a business, specify both the
legal name and any assumed name in which the business is being conducted. The defendant is the person
being sued. If you are suing a business, state its legal name if you know it. If you do not know its legal name,
state the name the business was using to conduct business. If there is more than one defendant, write the
words “et al.” after the name of the defendant and write the additional names and addresses on a separate
sheet of paper.
3
Check the box that is true. If another civil case was led that involved the plaintiff and defendant regarding the
same problem stated in this claim, write the name of the court where the case was led, the case number, and
the name of the judge assigned to hear that case. Check the box whether that case is or is not still pending.
4
A person other than the plaintiff can complete and sign this form. Read page 3 and then check the box that
best describes your relationship to the plaintiff. If you are the plaintiff, check the box “plaintiff.” If you are a
partner and you are suing for the partnership, check the box “a partner.” If you are a full-time employee of
the plaintiff and are suing for the plaintiff, check the box “a full-time employee of the plaintiff.”
5
The plaintiff can be either: 1) an individual, 2) a partnership, 3) a corporation, 4) a sole proprietor (a private
business owner without a partner), or 5) an other organization. Check the box that best describes the plaintiff,
and if applicable, complete the blank for “other.”
6
The defendant can be either: 1) an individual, 2) a partner in a business partnership, 3) a corporation, 4) a sole
proprietor (a private business owner without a partner), or 5) an other organization. Check the box that best
describes the defendant, and if applicable, complete the blank for “other.” If there is more than one defendant,
you will need to provide this information for each defendant.
7
Write in the date that the dispute occurred. For example, if the defendant owed money on a certain date and
did not pay on that date, print that date here. Or, if the defendant damaged something that belonged to you,
print the date that the damage occurred.
8
Write in the amount of the money owed or that you believe is owed to cover any damage even if it is more than
$7,000. If the amount is more than $7,000 and the case is decided in the small claims division of the district
court, the plaintiff gives up the right to any amount over $7,000. The plaintiff cannot le another form to get a
judgment for the balance. If the plaintiff wants a judgment for an amount over $7,000 and the claim is for
$25,000 or less, a lawsuit must be led in the civil division of the district court.
9
Briey explain the reasons for the claim. Include what happened to cause the dispute.
10
Make sure that you understand and agree with this statement.
11
Check the boxes that are most accurate.
12
Check the box that is most accurate.
DO NOT SIGN YOUR NAME until you are standing in front of a notary or the clerk of the court.
DO NOT WRITE IN THE SECTION AFTER ITEM 12. The notary public or clerk of the court will complete this section.
File your afdavit and claim with the court. The clerk of the court will complete the notice of hearing. See page 4 of this packet
for details.
• Read pages 3 through 5 of this booklet for details on ling and serving this form.
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