Civil Complaint-Commercial Creditor-Contract Action {SCA-M208}

-RETURN -DEFENDANT W. Va. Code 247247 55-8-7, 50-4-1, 50-5-8(a); Mag. Ct. Civ. Rules 2, 6A -FILE SCA-M208-1 / 5-02 -PLAINTIFF Docket Code(s): ($MCIC0 | $MCIC1 | $MCIC2 | $MCIC3 | $MCIC4) IN THE MAGISTRATE COURT OF COUNTY, WEST VIRGINIA Name, Address & Phone Number of Plaintiff: Magistrate Court Case No. V. Name, Address & Phone Number of Defendant(s): CIVIL COMPLAINT COMMERCIAL CREDITOR/CONTRACT ACTION --- Fold Here --- --- Fold Here --- T he above - named plaintiff or , on behalf of the plaintiff acting in the capacity of , alleges the following as true and accurate: and made a contract or note, dated . The defendant(s) is (are) in arrears for $ or has (have) otherwise breached the terms of the contract or note in the following manner: . ORIGINAL OBL IGATION: PAYMENTS CREDITED TO (NOTE: Attach a page listing the dates & amount of each payment): Principal $ Principal $ Interest $ Interest (Beginning , 20 ) $ Insurance & Other $ Other Charges $ Rebate of Unearned Interest $ TOTAL $ Rebate of Other Charges (insurance, etc.) $ Sale of Repossessed Collateral $ TOTAL $ $ ( - ) $ (=) $ (Total of original obligation) (Subtract) (Total payments credited) (Equals) BA LANCE DUE List any collateral: American LegalNet, Inc. www.FormsWorkFlow.com -RETURN -DEFENDANT W. Va. Code 247247 55-8-7, 50-4-1, 50-5-8(a); Mag. Ct. Civ. Rules 2, 6A -FILE SCA-M208-1 / 5-02 -PLAINTIFF Docket Code(s): ($MCIC0 | $MCIC1 | $MCIC2 | $MCIC3 | $MCIC4) Civil Complaint: Commercial Creditor/Contract Action - Page 2 of 2 Magistrate Court Case No.: The plaintiff requests the following re lief from the court: Plaintiff222s Signature Date Taken, subscribed, and sworn or affirmed before me this day of 20 . My commission expires on . Notary Public/Magistrate Assistant/Magistrate Clerk NOTICE: Any party in a civil action seeking over $20.00 has the right to elect that the case be tried by a jury. You must give written notice to the magistrate court 20 days from when the first timely answer to the complaint is made If you do not notify the magistrate court within the appropriate time period, you give up your right to jury trial. The jury fee will be assessed against the losing party if the case is tried by a jury or may be prorated between the parties if the case is settled before trial. I have read and understood this, and my signature below indicates that I wish to have a jury trial. Signature Date NOTICE: Any person involved in court proceedings who has a disability and needs special accommodation should inform the court sufficiently in advance so that arrangements can be made if possible. American LegalNet, Inc. www.FormsWorkFlow.com