Small Claims Application

Hartford Town Court

165 Hartford Main Street

Granville, NY12832

Telephone (518) 632-9274

Fax (518) 632-0032

Hon. Sharon Schofield
Town Justice

Stephanie Euber
Court Clerk

Application for Small Claims Action

Date: ____________________
Filing Fees:

Claim up to $1000.00 =  $10.00
Claim $1001.00 to $3000.00 = $15.00

              (Payable in Cash, Money Order, Certified Check, MasterCard or VISA ONLY)

 

Plaintiff:  (Please PRINT clearly)

 

Name: _________________________________________________________________________

Address:  _________________________________________________________________________

_________________________________________________________________________

Telephone #: ____________________________________

 

Defendant:  (Please PRINT clearly)

 

Name: _________________________________________________________________________

Address:  _________________________________________________________________________

_________________________________________________________________________

Telephone #: ____________________________________

 

Total Amount of claim: $ _____________________ ( Can NOT exceed $3000.00)

 

Nature of claim: (Please PRINT clearly) __________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

 

Signature of Applicant: ________________________________________________________________

 

For Court Use Only – Do Not Write Below This Line

 

Docket # _______________________                   Court Date: ____