The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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STATEMENT OF SMALL CLAIM

AND NOTICE

DOCKET NO. (For Court Use Only)

Trial Court of Massachusetts
Small Claims Session

NOTICE TO PLAINTIFF: You may file your small claim only in the court for the area where either the plaintiff or the defendant lives or has a place of
business or employment. A small claim against a landlord arising from the rental of an apartment may also be brought where the apartment is located. You
may find it easier to enforce a decision in your favor if you bring your small claim where the defendant lives or works, but you are not required to do so.
COURT DIVISION WHERE THE PLAINTIFF IS FILING THIS CLAIM (Select Only One Court):

PLAINTIFF INFORMATION: The person filing the claim is the plaintiff.

PLAINTIFF'S ATTORNEY (if any)

DEFENDANT(S) INFORMATION: The person or corporation being sued is the defendant. If you are suing a company which is not a corporation, you
should name the owner(s) doing business as the named company as the defendant; the names of the owner(s) can be obtained from the City or Town Clerk
where the company's offices are located. If you are suing a company which is a corporation, you must have the exact legal name. You can find this
information from the Corporate Records Division of the Secretary of State's Office, One Ashburton Place, Room 1712, Boston, MA 02108.

BBO NO:

BMC:

District:

Housing:

Pltf. Name:

Address:

City/State/Zip:

Phone No.:

Def. #1 Name:

Address:

City/State/Zip:

Phone No.:

Atty. Name:

Address:

City/State/Zip:

Phone No.:

Def. #2 Name:

Address:

City/State/Zip:

Phone No.:

PLAINTIFF'S CLAIM: Fill in below the amount you are suing for and briefly explain your claim. State your claim clearly so the defendant
can understand why he or she is being sued. Give the date of the event that is the basis of your claim. Fill in as "costs" the amount of the
filing fee.
The Plaintiff claims that the Defendant(s) OWE plus court costs for the following reasons:

SIGNATURE OF PLAINTIFF: X

DATE:

MEDIATION: Mediation of this claim may be available if both parties agree to discuss the matter with a mediator, who will assist the parties
in trying to resolve the dispute on mutually agreed to terms. The plaintiff must notify the court if he or she desires mediation; the defendant
may consent to mediation on the trial date. The plaintiff is willing to attempt to settle this claim through mediation: YES NO

MILITARY AFFIDAVIT: The plaintiff states under the pains and penalties of perjury that the:

above defendant(s) is (are) not serving in the military and at present live(s) or works at the above address.

above defendant(s) is (are) serving in the military.

I am unsure if the above defendant(s) is (are) in the military.

SIGNATURE OF PLAINTIFF: X

DATE:

INSTRUCTIONS TO PLAINTIFF: "By E-Filing this form, which includes the military affidavit, you certify that the above information is true and
accurate. By completing this form, together with a payment of the filing fee, the form will be sent to the court electronically. If you do not know
where to file your Small Claims case visit: www.mass.gov/courthouse-locator. If a claim arises out of plaintiff's trade or commerce, or for
assigned debt, you may be required to complete and file a "Verification of Defendant's Address" form."

Efile: 6/5/2018

www.mass.gov/courts

Statement of small claims and notice for eFiling (select District Court

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Massachusetts state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.mass.gov (2023-03)
Page(s): 1
Fields(s): 33
Average fields per page: 33
Reading Level: Grade 9
LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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form_page_set_square_box__1 was form1[0].#pageSet[0].Page1[0].SquareBox1[0] (0.37 conf)
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form_page_set_square_box__3 was form1[0].#pageSet[0].Page1[0].SquareBox3[0] (0.37 conf)
form_page_set_yes_chkbox was form1[0].#pageSet[0].Page1[0].Yes_chkbox[0] (0.36 conf)
form_page_set_chkbox was form1[0].#pageSet[0].Page1[0].No_chkbox[0] (0.36 conf)
form_page_set_date_field was form1[0].#pageSet[0].Page1[0].DateField1[0] (0.40 conf)
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set_dept_h_c_drop was form1[0].#pageSet[0].Page1[0].DeptDropdownsubform[0].HC_DropDw[0] (0.37 conf)
form_signature_plaintiff__1 was form1[0].#subform[0].signature_plaintiff[0] (0.34 conf)
form_plaintiff_date__1 was form1[0].#subform[0].signature_plaintiff_date1[0] (0.49 conf)
form_signature_plaintiff__2 was form1[0].#subform[0].signature_plaintiff1[0] (0.34 conf)
form_plaintiff_date__2 was form1[0].#subform[0].signature_plaintiff_date[0] (0.49 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Statement of small claims and notice for eFiling (select District Court

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02