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Description of Counter Claim:
Amount of Counter Claim __________________
Signature: ______________________________ Date: ____/____/____
COUNTER CLAIM FEE: $3.00 PLUS POSTAGE
FEE: $1.00 to $1,000.00 $10.00 Rec# _________ $1,001.00 to $3,000.00 $15.00 Rec# _________ **Booklet provided to Plaintiff _____ **Booklet mailed to Plaintiff _____ Defendant _____ **Clerk Taking Claim __________________ TRIAL DATE: __________________
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