File No.

STATE OF NORTH CAROLINA

In The General Court Of Justice
County District Court Division-Small Claims
COMPLAINT
1. The defendant is a resident of the county named above.
FOR MONEY OWED
2. The defendant owes me the amount listed for the following reason:

G.S. 7A-216, 7A-232

Principal Amount Owed $
Name And Address Of Plaintiff

Interest Owed (if any) $

Total Amount Owed $

(check one below)

County Telephone No. Date From Which Interest Due Interest Rate
On An Account (attach a copy of the account)
Beginning Date Ending Date Interest Rate
VERSUS
Name And Address Of Defendant 1 Individual Corporation
For Goods Sold And Delivered Between
Date From Which Interest Due Interest Rate
For Money Lent
Date Of Note Date From Which Interest Due Interest Rate
On a Promissory Note (attach copy)

For a Worthless Check (attach a copy of the check)

County Telephone No.
For conversion (describe property)
Name And Address Of Defendant 2
my friend g
Individual Corporation

Other: (specify)

County Telephone No.

Name And Address Of Plaintiff's Attorney

I demand to recover the total amount listed above, plus interest and reimbursement for court costs.

Date Name Of Plaintiff Or Attorney (Type Or Print) Signature Of Plaintiff Or Attorney

(Over)

AOC-CVM-200, Rev. 9/13

© 2013 Administrative Office of the Courts
 INSTRUCTIONS TO PLAINTIFF OR DEFENDANT
1. The PLAINTIFF must file a small claim action in the county where at least 6. The DEFENDANT may file a written answer, making defense to the
one of the defendants resides. claim, in the office of the Clerk of Superior Court. This answer
should be accompanied by a copy for the plaintiff and be filed no
2. The PLAINTIFF cannot sue in small claims court for more than $10,000.00. later than the time set for trial. The filing of the answer DOES NOT
This amount may be lower, depending on local judicial order. If the amount relieve the defendant of the need to appear before the magistrate to
is lower, it may be any amount between $5,000.00 and $10,000.00, as assert the defendant's defense.
determined by the chief district court judge of the judicial district.
7. Whether or not an answer is filed, the PLAINTIFF must appear
3. The PLAINTIFF must show the complete name and address of the before the magistrate.
defendant to ensure service on the defendant. If there are two defendants
and they reside at different addresses, the plaintiff must include both 8. The PLAINTIFF or the DEFENDANT may appeal the magistrate's
addresses. The plaintiff must determine if the defendant is a corporation decision in this case. To appeal, notice must be given in open court
and sue in the complete corporate name. If the business is not a when the judgment is rendered, or notice may be given in writing to
corporation, the plaintiff must determine the owner's name and sue the the Clerk of Superior Court within ten (10) days after the judgment is
owner. rendered. If notice is given in writing, the appealing party must also
serve written notice of appeal on all other parties. The appealing
4. The PLAINTIFF may serve the defendant(s) by mailing a copy of the party must PAY to the Clerk of Superior Court the costs of court for
summons and complaint by registered or certified mail, return receipt appeal within twenty (20) days after the judgment is rendered.
requested, addressed to the party to be served or by paying the costs to
have the sheriff serve the summons and complaint. If certified or 9. This form is supplied in order to expedite the handling of small
registered mail is used, the plaintiff must prepare and file a sworn claims. It is designed to cover the most common claims.
statement with the Clerk of Superior Court proving service by certified
mail and must attach to that statement the postal receipt showing that the 10. The Clerk or magistrate cannot advise you about your
letter was accepted.
case or assist you in completing this form. If you
5. The PLAINTIFF must pay advance court costs at the time of filing this have any questions, you should consult an attorney.
Complaint. In the event that judgment is entered in favor of the plaintiff,
court costs may be charged against the defendant.

AOC-CVM-200, Rev. 9/13

© 2013 Administrative Office of the Courts