The statement of claim, verification, and notice shall be in substantially the following form:

Magistrate Court of County

State of Georgia

Plaintiff

Address

v.

Defendant

Statement of Claim

(Here the plaintiff or, at his or her request, the court will insert a

brief statement of the plaintiff's claim or claims giving the defendant

reasonable notice of the basis for each claim and, if the action is on a

contract, either express or implied, the original statement of the

plaintiff's claim which is to be filed with the court may be verified by

the plaintiff or his or her agent as follows:)

STATE OF GEORGIA

COUNTY OF

, being first duly sworn on oath, says the foregoing is a just

and true statement of the amount owing by defendant to plaintiff, exclusive

of all setoffs and just grounds of defense.

Plaintiff or agent

Sworn and subscribed

before me this day

of , .

Notary public

or attesting

official

Notice

TO:

Defendant

Home Address

or

Business Address

You are hereby notified that has made a claim and is requesting

judgment against you in the sum of dollars ($ ), as shown by

the foregoing statement. The court will hold a hearing upon this claim at

(address of court) at a time to be set after your answer is filed.

YOU ARE REQUIRED TO FILE OR PRESENT AN ANSWER TO THIS CLAIM WITHIN 30

DAYS AFTER SERVICE OF THIS CLAIM UPON YOU. IF YOU DO NOT ANSWER, JUDGMENT

BY DEFAULT WILL BE ENTERED AGAINST YOU. YOUR ANSWER MAY BE FILED IN WRITING

OR MAY BE GIVEN ORALLY TO THE JUDGE.

If you have witnesses, books, receipts, or other writings bearing on

this claim, you should bring them with you at the time of hearing.

If you wish to have witnesses summoned, see the court at once for

assistance.

If you have any claim against the plaintiff, you should notify the court

at once.

If you admit the claim, but desire additional time to pay, you must come

to the hearing in person and state the circumstances to the court.

You may come with or without an attorney.

Magistrate of

County