NORWICH CITY COURT   :   COUNTY OF CHENANGO
FILING FEE:  Money Order, Certified Bank Checks or Cash only. Fee must accompany application
 

Type of Claim	Filing Fee
Small Claims - $1,000 or less	$15.00
Small Claims - exceeding $1,000 up to $3,000	$20.00
Counterclaim	$5.37* *EFFECTIVE 6/30/02 - $3.37

Date: ___________________________________

Name of  Claimant:______________________________________________________________________________

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Address

Telephone no.: ___________________________________________________________________________________
               (Work)      (Home)
against

Name of   Defendant(s):________________________________________________________________(if a business -provide business name AND name of  individual who owns/operates/manages business)

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Address (Home or Business./Place of Employment must be in Chenango  County - except for counterclaims)

Amount of Claim $__________________________  (Do not include filing fee in this amount)
Nature of Claim to include all pertinent information including descriptions, dates, addresses, etc.  Attach additional documents if necessary.
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SIGNATURE OF PERSON FILING CLAIM: