Superior Court of the District of Columbia
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Small Claims Form 11 |
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CIVIL DIVISION |
General |
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SMALL CLAIMS AND CONCILIATION BRANCH |
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Bldg. B, 510 4th Street, N.W., RM –120 |
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WASHINGTON, D.C. 20001 |
TELEPHONE 879-1120 |
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____________________________________ |
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(1) ______________________________________ |
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Plaintiff(s) |
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Defendant(s) |
____________________________________ |
vs. |
(2) ______________________________________ |
____________________________________ |
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(3) ______________________________________ |
Address |
Zip Code |
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Phone No. ______________________ |
No. SC ______________ |
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STATEMENT OF CLAIM
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DISTRICT OF COLUMBIA, ss: ______________________________________________________ being first duly sworn on oath says
the foregoing is a just and true statement of the amount owing by the defendant to plaintiff, exclusive of all set-offs and just grounds of defense.
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Plaintiff /Agent (Sign and Print Name) |
Address |
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___________________________________________ |
Title:______________________________________________________ |
City/State/Zip Code |
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Phone No.: __________________________________ |
Subscribed and sworn to before me this __________ day of ____________________________________________, 20 ________
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(month and year) |
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____________________________________________________ |
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Deputy Clerk (or notary public) |
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Attorney for Plaintiff (Sign and Print Name) |
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______________________________________________________ |
Address |
Zip Code |
Bar No.: _____________________Phone No.: ________________
NOTICE (All parties must notify the court of any address changes.)
To: |
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(1) ___________________________________________ |
(2) _____________________________________________________ |
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Defendant |
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Defendant |
_____________________________________________ |
_____________________________________________________ |
Address |
Zip Code |
Address |
Zip Code |
Home |
Business |
Home |
Business |
You are hereby notified that ___________________________________________________________________________________
______________________________________________________________________ has made a claim and is requesting judgment
against you in the sum of ___________________________________________________________ dollars ($__________________),
as shown by the foregoing statement. The court will hold a hearing upon this claim on ____________________________________
__________________________________________________________________________________________________________
at 9:00 a.m. in the Small Claims and Conciliation Courtroom 119, Bldg. B, 510 4th Street, N.W.,
SEE REVERSE SIDE FOR COMPLETE INSTRUCTIONS BRING THIS NOTICE WITH YOU AT ALL TIMES
Deputy Clerk
Small Claims and Conciliation Branch
INSTRUCTIONS TO DEFENDANTS
IMPORTANT: IF YOU FAIL TO APPEAR AT THE TIME STATED OR AT ANY OTHER TIME THE COURT NOTIFIES YOU TO DO SO, A JUDGMENT BY DEFAULT MAY BE ENTERED AGAINST YOU FOR THE MONEY, DAMAGES OR OTHER RELIEF DEMANDED IN THE STATEMENT OF CLAIM. IF THIS OCCURS, YOUR WAGES OR BANK ACCOUNT MAY BE ATTACHED OR WITHHELD OR ANY PERSONAL PROPERTY OWNED BY YOU MAY BE TAKEN AND SOLD TO PAY THE JUDGMENT. DO NOT FAIL TO APPEAR AT THE REQUIRED TIME.
Before any case goes to trial in the Small Claims and Conciliation Branch, a trained mediator will meet with all parties to see if a settlement can be worked out. If all parties are present when your case is called, you and the plaintiff will be able to see a mediator and hopefully settle your dispute without having to go to trial.
You may come with or without a lawyer. The Statement of Claim indicates whether the plaintiff has a lawyer. If the plaintiff does have a lawyer and you wish to dispute the claim, it would be in your best interest to have your own lawyer.
If you wish to have legal advice and feel that you cannot afford to pay a fee to a lawyer, you may contact the Neighborhood Legal Services Program at (202) 269-5100, the DC Law Students in Court Program at (202) 638-4798, Legal Counsel for the Elderly at
(202)434-2170 or the Legal Aid Society at (202) 628-1161. If you need further help, come to Building B, 510 4th Street, N.W., Room 120, for more information concerning places where you may ask for such help. You may also consult the legal aid directory on www.lawhelp.org/dc. Act promptly.
If it is impossible for you to appear on the date of trial, attempt to contact the Plaintiff to arrange a new date. If parties agree on a date, notify the clerk of the Small Claims Branch of this court in person or by phone of the new date. If parties cannot agree, you may contact the clerk who will inform you regarding procedures. If you do not appear on the new date, a judgment may be entered against you.
Whenever correspo di g with the S all Clai s lerk’s offi e y ail, please i lude your ase u er a d your date to appear in court.
You are given the following additional instructions in the event that you intend to appear without a lawyer:
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 clerk at once for assistance.
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.
PUEDE OBTENERSE COPIAS DE ESTE FORMULARTO EN ESPAÑOL EN EL TRIBUNAL SUPERIOR DEL DISTRITO DEL COLUMBIA, BUILDING B, 510 4TH STREET N.W., SALA 120.
YOU MAY OBTAIN A COPY OF THIS FORM IN SPANISH AT THE SUPERIOR COURT OF D.C. BUILDING B, 510 4TH STREET N.W., ROOM 120.