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CASE NO. Plaintiff Address IN THE SMALL CLAIMS COURT PRECINCT FIVE City State Zip Vs. ANGELINA COUNTY TEXAS Defendant PLAINTIFF S ORIGINAL PETITION the sum of which can t exceed 10 000. 00 for Plus Court cost interest as allowed by law and that there are no counterclaims existing in favor of the defendant and against the plaintiff* The above-named defendant Is not in the military service on active duty and is not a dependant of a service member on active duty. Is in the military service on active duty. I have been unable to determine whether or not the defendant is in the military service on active duty. Plaintiff Signature Phone Number Subscribed and sworn to before me this the day of 201. Judge / Clerk of the Court / Notary Public. 00 for Plus Court cost interest as allowed by law and that there are no counterclaims existing in favor of the defendant and against the plaintiff* The above-named defendant Is not in the military service on active duty and is not a dependant of a service member on active duty. Is in the military service on active duty. I have been unable to determine whether or not the defendant is in the military service on active duty. Is in the military service on active duty. I have been unable to determine whether or not the defendant is in the military service on active duty. Plaintiff Signature Phone Number Subscribed and sworn to before me this the day of 201. Judge / Clerk of the Court / Notary Public. 00 for Plus Court cost interest as allowed by law and that there are no counterclaims existing in favor of the defendant and against the plaintiff* The above-named defendant Is not in the military service on active duty and is not a dependant of a service member on active duty. Is in the military service on active duty. I have been unable to determine whether or not the defendant is in the military service on active duty. Plaintiff Signature Phone Number Subscribed and sworn to before me this the day of 201. Judge / Clerk of the Court / Notary Public.

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