"Small Claim and Notice of Small Claim" - Oregon

Small Claim and Notice of Small Claim is a legal document that was released by the Oregon Circuit Courts - a government authority operating within Oregon.

Form Details:

  • Released on February 1, 2022;
  • The latest edition currently provided by the Oregon Circuit Courts;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Circuit Courts.

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I
C
C
S
O
N THE
IRCUIT
OURT OF THE
TATE OF
REGON
C
FOR THE
OUNTY OF
Small Claims Department
Case No: ___________________
Plaintiff
SMALL CLAIM AND
(Inmate SID #, if applicable, _____________)
NOTICE OF SMALL CLAIM
v.
Filing fee at ORS 46.570
Subject to UTCR 5.180(3)
Defendant
Subject to ORS 646A.670(1) and UTCR
5.180(2)
Defendant is a public body
PLAINTIFF (
DEFENDANT (
Additional on attached page)
Additional on attached page)
Name
Name (enter Registered Agent, if necessary, on next page)
Street
Street (do not use a P.O. Box)
City / State / Zip
City / State / Zip
Phone
County
Phone
County
 I need an interpreter:
Spanish
ASL
other: _____________________
I, Plaintiff, claim that on or about (date)
, the above-named defendants owed me the sum
of (or property valued at) $_____________ because
, and this amount is still due.
I have paid (or will pay):
Claim
$______________
filing fees of $_____________
+ Fees $______________
+Costs $______________
and service costs of $____________
TOTAL $______________
Small Claim and Notice of Small Claim
OJD O
FFICIAL
Page 1 of 3
(Feb 2022)
I
C
C
S
O
N THE
IRCUIT
OURT OF THE
TATE OF
REGON
C
FOR THE
OUNTY OF
Small Claims Department
Case No: ___________________
Plaintiff
SMALL CLAIM AND
(Inmate SID #, if applicable, _____________)
NOTICE OF SMALL CLAIM
v.
Filing fee at ORS 46.570
Subject to UTCR 5.180(3)
Defendant
Subject to ORS 646A.670(1) and UTCR
5.180(2)
Defendant is a public body
PLAINTIFF (
DEFENDANT (
Additional on attached page)
Additional on attached page)
Name
Name (enter Registered Agent, if necessary, on next page)
Street
Street (do not use a P.O. Box)
City / State / Zip
City / State / Zip
Phone
County
Phone
County
 I need an interpreter:
Spanish
ASL
other: _____________________
I, Plaintiff, claim that on or about (date)
, the above-named defendants owed me the sum
of (or property valued at) $_____________ because
, and this amount is still due.
I have paid (or will pay):
Claim
$______________
filing fees of $_____________
+ Fees $______________
+Costs $______________
and service costs of $____________
TOTAL $______________
Small Claim and Notice of Small Claim
OJD O
FFICIAL
Page 1 of 3
(Feb 2022)
DECLARATION OF GOOD FAITH EFFORT
I, Plaintiff, have made a good faith effort to collect this claim from the defendants before filing this claim
with the court clerk.
(Describe your efforts):
If this case is subject to ORS 646A.670(1) (see the box at the top of page 1)
See the Oregon Judicial Department website for information about debt collection cases:
www.courts.oregon.gov/debtcollection
I have complied with ORS 646A.670(1) and UTCR 5.180. A completed Consumer Debt Collection
Disclosure Statement is attached and incorporated into this pleading as required by UTCR 5.180(2)(iii).
I hereby declare that the above statements are true to the best of my knowledge
and belief. I understand they are made for use in court and I am subject to penalty
for perjury.
Date
Plaintiff Signature
Plaintiff Name (print)
DEFENDANT’S REGISTERED AGENT:
Name
Street (do not use a P.O. Box)
City / State / Zip
Phone
County
Small Claim and Notice of Small Claim
OJD O
FFICIAL
Page 2 of 3
(Feb 2022)
NOTICE TO DEFENDANT:
READ THESE PAPERS CAREFULLY!
Within 14 DAYS* after receiving this notice you MUST do ONE of the following things
in writing:
• Pay the claim plus filing fees and service expenses paid by plaintiff (send
payment directly to the plaintiff, not to the court) OR
• Demand a hearing and pay the fee required (below) OR
• Demand a jury trial and pay the fee required (below). This option is available
only if amount claimed is more than $750.
If you fail to do one of the above within 14 DAYS* after you get this notice, the plaintiff
may ask the court to enter a judgment against you. The judgment will be for the amount
of the claim, plus filing fees and service costs paid by the plaintiff, plus a prevailing party
fee. If you are not able to respond in time because you are in active military service of
the United States, talk to a legal advisor about the Servicemembers Civil Relief Act.
COURT NAME / ADDRESS / PHONE #
>
>
>
Defendant’s Filing Fees (must be filled in by the PLAINTIFF):
(1) To demand a hearing if the amount claimed is $2,500 or less
$ ______
(2) To demand a hearing if the amount claimed is more than $2,500
$ ______
(3) To demand a jury trial (only if amount claimed is over $750)
$ ______
You can fill out and file your Response online at
If you
www.courts.oregon.gov/iforms.
have questions about filing procedures, go to www.courts.oregon.gov. Or you may
contact the court clerk. The clerk cannot give you legal advice about the claim.
*NOTE: If the plaintiff is an adult in custody (ORS 30.642) AND the defendant is a
government agency or other public body (ORS 30.260), the defendant must respond
within 30 days after receiving this Notice.
Small Claim and Notice of Small Claim
OJD O
FFICIAL
Page 3 of 3
(Feb 2022)
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