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: ____