Houdek (2) FlLED
� Conciliation Court
State of Minnesota _ �� - - : _ - -
County Judicial District Case No.
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STATEMENT OF CLAIM AND SUMMONS � R E C E I V
Plaintiff#1
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PLAINTIFF'S STATEMENT OF CLAIM ��.-
�1 l. The Defendant(s)ow s)me$��`l l 5 . �� ,plus filing fees and costs of$ 7 S ��� ,for a total
of$�5'�6?. aa � because(state what happened and when it happened):
u, e� o.�.► em e� c c i�. 11-1 o�n d w a ed . u
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❑ 2. The Defendant(s)has/have the following property that belongs to me(list property),
valued at
$ ,plus filing fees and costs of$ ,for a total of$
I want the Court to order this property returned to me or make the Defendant(s)pay me money for the value of
the property.
3. I believe the person(s)I am suing is/are at least 18 years old and not in the military.service.
Defendant#1 date of birth Defendant#2 date of birth
4. I understand that if I do not come to court on my hearing date,my case will be dismissed and I may have to pay
money to the Defendant(s)on any counterclaim that has been filed.
NOTARY STAMP OR COURT SEAL SWORN TO BEFORE ME ON: O�OVEOS�TEME�1'OOF C ILAIM IS DGE�D
nMrnMr Date: 7�5— I �` Signature•
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��J�- ��LiNDA L. �-'EARSC7N �/ Name: CJ1fP� 1� K-
� - �lotaryPublic-Minnesota signacure:l A�-- �`°"'�' Title(ifrepresentative):
'�+°�;•�'``�My Gommission Expires Jan 31,2oi 5 Telephone: 6�1-�i 9 9-tt o F��
� Plaintiff#1 date of b'vth b�1 / �o�1 A SC 7
Plaintiff#2 date of birth
Notice of Settlement
The above-entitled case haviug been settled,the same may be and hereby is dismissed with my consent.
Date: Plaintiff s Signature:
SUMMONS: IMPORTANT NOTICE TO THE PARTIES
You must come to court for a hearing on at _�� �•m• at
S ate �
� Locatio d s
If you do not come to court for this hearing,you may lose the case and have to pay money to the other party.
Dated: �- ' ' � � Court Administrator/Deputy � �
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INSTRUCTIONS
• Failure to Appear: If Defendant does not come to Court for the scheduled hearing, the Defendant may
lose the case and have to pay money to the Plaintiff. If Plaintiff does not come to Court for the scheduled
hearing, the case may be dismissed and the Plaintiff may have to pay money to the Defendant on any
counterclaim that has been filed.
� Counterclaims: If the Defendant wants to bring a counterclaim against the Plaintiff, it must be filed, along
with a filing fee, at least five days (not including Saturdays, Sundays, and holidays) before the scheduled
hearing date. The Court will then notify the Plaintiff of any such counterclaim. The Court will hear both
the claim and counterclaim at the same time. If the counterclaim exceeds the jurisdictional limit of the
Conciliation Court, see Rule 510 of Minnesota General Rules of Practice for the District Courts.
• Evidence and Witnesses: Each party must bring to the hearing all witnesses and exhibits, including repair
bills and estimates, deemed necessary to prove his or her case. Upon request, the Court will issue
subpoenas requiring witnesses to appear.
• Trials: After hearing the evidence, the Judge will either issue an order right away or take the case under
advisement and issue an Order at a later date. The parties will be notified by mail of the Judge's decision. If
a party changes his or her address, the Court must be notified.
• Settlement: If the parties agree on a settlement prior to the hearing, each parly who has made a claim or
counterclaim must promptly tell the Court in writing that the claim or counterclaim has been settled and that
it may be dismissed.
• The Plaintiff may notify the Court by completing and filing with the Court the Notice of Settlement
section on the Statement of Claim form.
NOTICE REGARDING CONTINUANCES
Change of Hearing Date: Requests for continuances must be received in writing not less than 5 business days
(working days only; Saturday, Sunday and Holidays are not counted) before the court date. No requests will be
accepted by phone.
The court administrator may change only one hearing date per party. All other requests for a change of hearing
date must be determined by the judge. All parties will be notified by the Court of any new hearing date.
The Court in its discretion may assess costs of not more than $50.00, either absolute or conditional, to the other
party as a condition of granting an order for a continuance of any case.
You must notify the court not less than 5 business days before the hearing if an interpreter is needed.
All questions and corresnondence should be addressed to the Conciliation Court at:
Ramsey County Conciliation Court
Room 170 Courthouse
� 15 W Kellogg Blvd
St Paul, MN, 55102-1618
Phone #651-266-8230
If payment is made to the prevailing party an original satisfaction of judgment must be filed with the court.