Form Claim Small PDF Details

In navigating the legal landscape of small claims in Michigan, understanding the "Affidavit and Claim, Small Claims" form is crucial for anyone looking to pursue legal action for claims under $6,500. This form, used within the Michigan Judicial District, lays the groundwork for initiating a case by detailing critical information such as plaintiff and defendant details, the nature of the claim, the amount being pursued, and any previous legal actions related to the claim. It emphasizes the limited nature of small claims court, including the relinquishment of rights to an attorney, a jury trial, and appealing the judge's decision. By setting a hearing date, it notifies both parties of the need to present their case and any evidence or witnesses that support their position. The form also outlines specifics regarding service to the defendant, setting expectations for the process leading up to the hearing. Furthermore, it includes provisions for accommodating disabilities and language interpretation, ensuring access and fairness in the judicial process. In essence, the "Affidavit and Claim, Small Claims" form is a vital document that guides plaintiffs through the procedural steps necessary to bring a small claim to court, encapsulating the legal requirements and procedural nuances that underpin the small claims process in Michigan.

QuestionAnswer
Form NameForm Claim Small
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesclaim small claims, small claim michigan, you claims small, how to claim small claims

Form Preview Example

STATE OF MICHIGAN JUDICIAL DISTRICT

AFFIDAVIT AND CLAIM

Small Claims

CASE NO. and JUDGE

Court address

See additional notice and instructions on page 3.

1.

Plaintiff

Address

City, state, zip

Telephone no.

2.

Defendant

Address

City, state, zip

Telephone no.

Court telephone no.

NOTICE OF HEARING

For Court Use Only

The plaintiff and the defendant must be in court on

DayDate

at

at

the court address above.

 

Time

 

 

 

 

 

 

 

 

.

 

 

Location

 

 

 

 

 

 

 

 

Fee paid: $

Process server’s name

 

 

 

 

3. A civil action between these parties or other parties arising out of the transaction or occurrence alleged in this

complaint has been previously filed in

this court

 

 

Court.

It was given case number

 

 

and assigned to Judge

 

.

The action

remains

is no longer

pending.

 

 

 

 

4. I have knowledge or belief about all the facts stated in this affidavit and I am

 

 

 

the plaintiff or his/her guardian, conservator, or next friend.

a partner.

a full-time employee of the plaintiff.

5.

The plaintiff is

an individual.

a partnership.

a corporation.

a sole proprietor.

 

 

6.

The defendant is

an individual.

a partnership.

a corporation.

a sole proprietor.

7.

The date(s) the claim arose is/are

 

 

 

 

 

 

 

 

Attach separate sheets if necessary

 

 

 

.

.

.

8.

Amount of money claimed is $

 

. (Note: Plaintiff’s costs are determined by the court and awarded as appropriate.

 

 

 

 

They are not part of the amount claimed.)

9.

The reasons for the claim are:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.The plaintiff understands and accepts that the claim is limited to $6,500 by law and that the plaintiff gives up the rights to

(a) recover more than this limit, (b) an attorney, (c) a jury trial, and (d) appeal the judge’s decision.

Approved, SCAO

Distribute form to:

Form DC 84, Rev. 1/21

Court (with instructions)

MCL 600.8401 et seq., MCR 4.302, MCR 4.303, 50 USC App 3931

Defendant (with instructions)

Page 1 of 3

Plaintiff (with instructions)

 

 

Return (with proof of service)

 

 

 

Affidavit and Claim, Small Claims (1/21)

Case No.

Page 2 of 3

 

11. I believe the defendant

is

is not

mentally competent. I believe the defendant

is

is not 18 years or

 

older.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

I do not know whether the defendant is in the military service.

 

The defendant is not in the military service.

 

The defendant is in the military service.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

Subscribed and sworn to before me on

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deputy clerk/Notary public signature

 

 

 

 

My commission expires on

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name (type or print)

 

 

 

 

Notary public, State of Michigan, County of

 

 

 

 

 

. Acting in the County of

 

 

.

This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

The defendant(s) must be served by

 

.

 

Expiration date

Affidavit and Claim, Small Claims (1/21)

Case No.

Page 3 of 3

 

ADDITIONAL NOTICE AND INSTRUCTIONS

TO BOTH THE PLAINTIFF AND THE DEFENDANT:

You must bring to the hearing all witnesses, books, papers, and other physical evidence needed to prove or disprove this claim.

Before the trial (hearing) starts, you have the right to

1.remove the case to the general civil division of the district court, or

2.have the case heard by a district court judge (if the hearing is scheduled before an attorney magistrate). If the case is heard by an attorney magistrate, you may appeal to the district judge within 7 days after the trial.

If the case is tried in the small claims division, you give up the right to an attorney, to a jury trial, and to appeal the judge's decision.

If you require accommodations to use the court because of a disability or if you require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements.

TO THE DEFENDANT:

The affidavit and claim you have just received means you are being sued in the small claims division of the district court.

The court is being asked to decide a matter that the plaintiff says is your obligation and responsibility.

If you wish to deny this claim or arrange terms of payment, you must make your request by appearing at the date, time, and place stated in the notice of hearing on the front of this form.

If you do not appear at the date, time, and place stated, a default judgment may be entered against you for the amount stated in item 8, including the costs of this action.

If the dispute is settled before or at the hearing, you may have to pay the plaintiff's costs.

In case a judgment is entered against you at the hearing, you should be prepared to pay the amount stated in item 8, including the costs of this action, or to make arrangements for installment payments.

Affidavit and Claim, Small Claims (1/21)

Case No.

PROOF OF SERVICE

TO PROCESS SERVER: You are to serve this affidavit and claim no later than 7 days before the hearing date. You must make and file your return with the court clerk. If you are unable to complete service, you must return this original and all copies to the court clerk.

 

 

CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE

 

 

I served

personally

by registered or certified mail (copy of return receipt attached)

a copy of the

affidavit and claim on:

 

 

 

I have attempted to serve the affidavit and claim and have been unable to complete service on:

Defendant’s name

Date and time of service

Place or address of service

Attachments (if any)

I declare under the penalties of perjury that this return of service has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Service fee

Miles traveled

Fee

 

$

 

 

 

 

$

 

 

 

 

 

Incorrect address fee

Miles traveled

Fee

TOTAL FEE

$

 

 

$

 

$

 

 

 

 

Signature

Name (type or print)

Title (if applicable)

Note: If documents are served by someone other than a sheriff, deputy sheriff, or other person listed in MCL 600.1910(b), this return must be notarized.

Subscribed and sworn to before me on

 

 

 

 

.

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deputy clerk/Notary public signature

 

My commission expires on

.

 

 

 

 

 

 

 

 

 

Name (type or print)

 

Notary public, State of Michigan, County of

 

 

 

. Acting in the County of

 

.

This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

ACKNOWLEDGMENT OF SERVICE

I acknowledge that I have received service of the affidavit and claim, together with

 

on

Attachments

 

Date and time

on behalf of

Signature

MCR 2.105

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