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*First & Last Name

 Sex Male

Female

*Street Address

*City

*State *Zip Code

99999-9999

*Phone

555-555-5555

*Email Address

*Birthday

MM/DD/YYYY

*Marital Status

*Occupation

*Defendant's Name

Age

Numbers only

Occupation

*What is the relationship between you & the defendant?

*How much are you suing for?

Numbers only

*When did the action that led to the lawsuit occur?

*Have you filed a small claims/civil case in court? Yes

No

If you answered "yes" to the above question, please answer the next three questions:

*In what court? *What is the docket number in your case?

*Is there a counterclaim? Yes

No

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