Transcription of Case Number: 27-CO-
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Case Number: 27-CO-
CCT102 Dist4 ENG Rev 04/16 Page 1 of 1 STATEMENT OF CLAIM AND SUMMONS STATE OF minnesota FOURTH JUDICIAL DISTRICT COUNTY OF HENNEPIN CONCILIATION COURT case Number: 27-CO- _____ The defendant(s) owe plaintiff(s) $_____, plus a $ _____ filing fee, for a total of $_____, plus costs, because on or about (month / year) _____, _____, the following event occurred. Briefly describe the event below. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. The person(s) being sued are at least 18 years old and are not in the military service. Signed: Date signed: County where signed: State where signed: Title of representative (if applicable): Daytime telephone: (_____) Plaintiff #1 Address City/State/Zip Date of Birth: Plaintiff #2 Address City/State/Zip Date of Birth: VERSUS Defendant #1 Address City/State/Zip Date of Birth: Defendant #2 Address City/State/Zip Date of Birth: Defendant #3 Address City/State/Zip Date of Birth: SUMMONS: IMPORTANT NOTICE TO THE PARTIES You are hereby summoned to appear at the hearing
CCT102 Dist4 ENG Rev 04/16 www.mncourts.gov/forms Page 1 of 1 STATEMENT OF CLAIM AND SUMMONS STATE OF MINNESOTA FOURTH JUDICIAL DISTRICT
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