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Ayia FILED
DATE: June4, 2024
TIME:14:44: 14 AM
"Â¥ACV023664-590 STATE OF NORTH CAROLINAVEcKLENBURG COUNTY
CLERK OF SUPERIOR COURT
BY: M. Jones In The General Court Of Justice
County District Court Division Small Claims
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1.The defendant is a resident of the county named above.
2. The defendant entered into possession of premises described below as a lessee of plaintiff.
Description Of Premises (include location and address)
COMPLAINT 0 Conventional
IN SUMMARY EJECTMENT [] Public Housing
Section 8
Rate Of Rent (Tenant's Share) Month Date Rent Due Date Lease Ended Type ease
$ per Week Oral [_] ;
3. The defendant failed to pay the rent due on the above date and the plaintiff made demand for the rent and waited the «
G.S. 7A-216,-7A-232; Ch. 42, Arts. 3 and 7
10-day grace period before filing the complaint.
e And Address Of Afaintiff
[] The lease period ended on the above date and the defendant is holding over after the end of the lease period.
The defendant breached the condition of the lease described below for which re-entry is specified.
Criminal activity or other activity has occurred in violation of G.S. 42-63 as specified below.
Tel Description Of Breach/Criminal Activi names,
unty
AGO gpl
VERSUS
Name And Address Of Defendant 1 Individual Corporation
UP whe PQ *-
D- (A0@ 4. The plaintiff has demanded possession of the premises from the defendant, who has refused to surrender it, and the
ERD plaintiff is entitled to immediate possession.
5. The defendant owes the plaintiff the following:
County No Description Of Any Property Damage
Name And Address Of Defendant 2 Individual Corporation
ee, e 5
Whe.
Amount Of Damage (if known)
bill Amount Of Rent Past Due
Og
Total Amount Due
$ $
County Telephone No. 6. 1demand to be put in possession of the premises and to recover the total amount listed above and daily rental unti! entry
of judgment interest and reimbursement for court costs.
Name And Address Of Plaintiff's Attomey Or Agent plus,
Date Name (type
:
CERTFICATION WHEN COMPLAINT SIGNED/BY AGENT OF PLAINTIFF :
I certify that am an agent of the plaintiff and have actual knowledge of the facts alleged in this Complaint
Attomey Bar No. Date Name Of Ageni (type or print) Signature Of Agent
(Over)
AOC-CVM-201, Rev. 8/17
© 2017 Administrative Office of the Courts
INSTRUCTIONS TO PLAINTIFF OR DEFENDANT
THE CLERK OR MAGISTRATE CANNOT ADVISE YOU ABOUT YOUR CASE OR ASSIST YOU IN COMPLETING THIS FORM.
IF YOU HAVE ANY QUESTIONS, YOU SHOULD CONSULT AN ATTORNEY.
. The PLAINTIFF must file a small claim action in the county where at least one of the 9. The DEFENDANT may file a written answer, making defense to the claim, in the
defendants resides. office of the Clerk of Superior Court. This answer should be accompanied by a copy
for the plaintiff and be filed no later than the time set for trial. The filing of the answer
2 . The PLAINTIFF cannot sue in small claims court for more than $10,000.00 excluding
DOES NOT relieve the defendant of the need to appear before the magistrate to
interest and costs unless further restricted by court order.
assert the defendant's defense.
3 . The PLAINTIFF must show the complete name and address of the defendant to
10. Requests for continuances of cases before the magistrate may be granted for good
ensure service on the defendant. If there are two defendants and they reside at
cause shown and for no more than five (5) days per continuance unless the parties
different addresses, the plaintiff must include both addresses. The plaintiff must
determine if the defendant is a corporation and sue in the complete corporate name.
agree otherwise.
If the business is not a corporation, the plaintiff must determine the owner's name 11. The magistrate will render judgment on the date of hearing unless the parties agree
and sue the owner. otherwise, or the case is complex as defined in G.S. 7A-222, in which case the
decision is required within five (5) days.
4. The PLAINTIFF may serve the defendant(s) by mailing a copy of the summons and
complaint by registered or certified mail, return receipt requested, addressed to the 12. The PLAINTIFF or the DEFENDANT may appeal the magistrate's decision in this
party to be served or by paying the costs to have the sheriff serve the summons and case. To appeal, notice must be given in open court when the judgment is entered, or
complaint. If certified or registered mail is used, the plaintiff must prepare and file a notice may be given in writing to the Clerk of Superior Court within ten (10) days after
sworn statement with the Clerk of Superior Court proving service by certified mail and the judgment is entered. If notice is given in writing, the appealing party must also
must attach to that statement the postal receipt showing that the letter was accepted. serve written notice of appeal on all other parties. The appealing party must PAY to
the Clerk of Superior Court the costs of court for appeal within ten (10) days after the
5. In filling out number 2 of the complaint in subsidized housing (e.g., Section 8.
judgment is entered. If the appealing party applies to appeal as an indigent, and that
voucher. housing authority), the landlord should include in the "Rate Of Rent" box
request is denied, that party has an additional five (5) days to pay the court costs for
only that portion of the rent that the tenant pays directly to the landlord. the appeal.
6. In filling out number 3 in the complaint, if the landlord is seeking to remove the
13. If the defendant appeals and wishes to remain on the premises the defendant must
tenant for failure to pay rent when there is no written lease, the first block shouldbe
also post a stay of execution bond within ten (10) days after the judgment is entered. In
checked. (Defendant failed to pay the rent due on the above date and the plaintiff
the event of an appeal by the tenant to district court, the landlord may file a motion to
made demand for the rent and waited the ten (10) day grace period before filing
dismiss that appeal under G.S. 7A-228(d). The court may decide the motion without a
the complaint.) If the landlord is seeking to remove the tenant for failure to pay rent
hearing if the tenant fails to file a response within ten (10) days of receipt of the motion
when there is a written lease with an automatic forfeiture clause, the third block
should be checked. (The defendant breached the condition of the lease described 14. Upon request of the tenant within seven (7) days of the landlord being placed in lawful
below for which re-entry is specified.) And "failure to pay rent" should be placed in possession, the landlord shall release any personal property of the tenant. If, after
the space for description of the breach. If the landlord is seeking to evict tenant for being placed in lawful possession by execution of a writ, the landlord has offered to
violating some other condition in the lease, the third block should also be checked. release the tenant's property and the tenant fails to retrieve such property during the
If the landlord is claiming that the term of the lease has ended and the tenant landlord's regular business hours within seven (7) days after execution of the writ,
refuses to leave, the second block should be checked. If the landlord is claiming that the landlord may throw away, dispose of, or sell the property in accordance with the
criminal activity occurred, the fourth block should be checked and the conduct must provisions of G.S. 42-25.9(g). If sold, the landlord must disburse any surplus proceeds
be described in space provided. to the tenant upon request within seven (7) days of the sale. If the total value of the
property is less than $500.00, it is deemed abandoned five (5) days after execution
7. The PLAINTIFF must pay advance court costs at the time of filing this Complaint.
unless the tenant requests, prior to expiration of the five-day period, release of the
In the event that judgment is rendered in favor of the plaintiff, court costs may be
property to the tenant, in which case the landlord shall release possession of the
charged against the defendant.
property to the tenant during regular business hours or at a time agreed upon.
8. The PLAINTIFF must appear before the magistrate to prove his/her claim.
15. This form is supplied in order to expedite the handling of small claims. It is designed
to cover the most common claims.
AOC-CVM-201, Side Two, Rev. 8/17
© 2017 Administrative Office of the Courts