SUPERIOR COURT OF THE DISTRICT OF COLUMBIA SMALL CLAIMS AND CONCILIATION BRANCH
(Location of room in (Address of
courthouse) court)
Washington, D.C.
__________________
Plaintiff
__________________
Address No. _______
vs.
__________________
Defendant
STATEMENT OF CLAIM
(Here the plaintiff, or at his request the clerk, will insert a statement of the plaintiff's claim, and the original, to be filed with the clerk, may, if action is on a contract, express or implied, be verified by the plaintiff or his agent, as follows:)
District of Columbia,ss:
____________ being first duly sworn on oath says the foregoing is a just and true statement of the amount owing by defendant to plaintiff, exclusive of all set-offs and just grounds of defense.
__________________.
Plaintiff (or agent)
Subscribed and sworn to before me this ______ days of _______, 19__.
__________________.
Clerk (or notary public)
NOTICE
To: ____________
Defendant
____________
Home address
____________
Business address
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 __m. in the Small Claims and Conciliation Branch (address of Court).
You are required to be present at the hearing in order to avoid a judgment by default.
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.
You may come with or without an attorney.
[seal] __________________
Clerk of the Small Claims and
Conciliation Branch, Superior Court of the District of Columbia
D.C. Code § 16-3902
Certified mail return receipts as prima facie evidence of delivery, see § 14-506. .