JUDGMENT / DISMISSAL
Small Claims
CASE NO.
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Plaintiff’s name and address
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Defendant’s name and address
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JUDGMENT
Judgement for
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Judgement for (use if more space is needed)
Judgement against
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Judgement against (use if more space is needed)
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Consent Judgement
Judgment Amount $
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IT IS ORDERED this Judgement is granted and:
The defendant must pay the judgement to
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Payment made:
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in full
installments of
Dollar amount of installments
Payment frequency
weekly
biweekly
monthly
Payments starting on
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PLAINTIFF DATE HERE
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PLAINTIFF SIGN HERE
DEFENDANT DATE HERE
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
DEFENDANT SIGN HERE
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