IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI
SMALL CLAIMS COURT
AT KANSAS CITY AT INDEPENDENCE
____________________________________________
PLAINTIFF(S)
____________________________________________ NO. ___________________________________
____________________________________________ _____________________________________
STREET ADDRESS DATE, TIME AND DIVISION OF HEARING
____________________________________________
CITY STATE ZIP
____________________________________________ Jackson County Service Requested
RES. PHONE WORK PHONE
Private Process Server
Certified Mail Service Requested
Delivery Restricted to Addressee
VS.
____________________________________________ Out of County Service _________________
DEFENDANT(S)
____________________________________________ ______________________________________
____________________________________________ ______________________________________
SERVICE ADDRESS
____________________________________________ ______________________________________
CITY STATE ZIP
COUNTERCLAIM PETITION
Defendant/Counterclaimant states that he/she has a claim against the Plaintiff, which arose on or about ________________________, in the
amount of $ _______________. Defendant/Counterclaimant is a resident of _____________________ County, in the State of _________________.
The claim arose in ____________________________________ County, the State of ___________________________, due to the following events:
Defendant/Counterclaimant states that the information contained in this petition is true and correct to the best of his/her knowledge. Defendant/Counterclaimant understands that should he/she be successful in this action and obtains a judgment, and if plaintiff/counterclaim defendant does not appeal within 10 days, this judgment becomes final. Defendant/Counterclaimant cannot commence another action involving the same parties and issues. Defendant/Counterclaimant also understands that any amount over the small claims monetary jurisdiction owed by defendant arising out of this transaction is deemed waived.
If this Counterclaim does not arise out of the same transaction, in addition to the above information, defendant/counterclaimant states that he/she is not an assignee of this counterclaim, and that to the best of his/her knowledge he/she has not filed more than twelve (12) other claims in Missouri small claims courts during the current calendar year.
DEFENDANT/COUNTERCLAIMANT IS HEREBY WAIVING HIS RIGHT TO JURY TRIAL ON THESE ISSUES IN THE SMALL CLAIMS COURT.
KEEP A COPY OF THIS COUNTERCLAIM
AND BRING TO COURT _______________________________________________
SIGNATURE OF DEFENDANT/COUNTERCLAIMANT
CIRCT 4208 – 04/10 ORIGINAL
(FILE IN COURT’S CASE FILE FOLDER)
INSTRUCTIONS TO THE PLAINTIFF
1. By this form, the defendant is countersuing you.
2. To defend yourself:
a. You must appear at the date and time set for hearing,
b. You should bring with you all books, papers, witnesses and evidence you have to establish your defense,
c. At your request, the clerk will issue subpoenas for any witness you may need.
3. Formal rules of evidence and civil procedure do not apply, and you may defend this action with or without the aid of an attorney.
KEEP A COPY OF THIS COUNTERCLAIM AND BRING IT TO COURT