Statement of Claim and Summons

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                          State of Minnesota FI L E D Conciliation Court
County
' OCT ol ag

Judicial District:
Court File Number:
ee Type:

SUMMONS

Phaintiff #2

City/State/Zip

SOI

PLAINTIFF’S STATEMENT OF CLAIM

1. The Defendant(s) owe(s) me $ a 719 7. 50 , Plus filing fees and costs of
oo
, fora total of $ x £67.50 because on or

(state month and year) the

0 2. The Defendant(s) has/have the following property that belongs to me (list property), __

valued at $
for a total of $ . 1 want the court to order this property returned to

plus filing fees and costs of $

me or make the Defendant(s) pay me money for the value of the property.

CCT102 State ENG Rev 8/15 www_mncourts.gow/forms Page 1 of 23. believe the person(s) I am suing is/are at least 18 years old and not in the military service.
Defendant #1 date of birth NWos Defendant #2 date of birth

4, L understand that if I do not come to court on my hearing date, my case may be dismissed
and I may have to pay money to the Defendant(s) on any countercla…