Small Claims Complaint

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

Massachusetts requires the use of the official Statement of Small Claim and Notice form for small claims
complaints. This template provides the substantive legal content to help you prepare —
but you must transfer your content to the official form before filing. The official form
is available at https://www.mass.gov/lists/small-claims-court-forms.
Do not file this document directly with the court.

COMMONWEALTH OF MASSACHUSETTS

__________ DIVISION – DISTRICT COURT DEPARTMENT

SMALL CLAIMS SESSION

Docket No.: [COURT TO ASSIGN]

SMALL CLAIMS COMPLAINT

(Filed pursuant to Mass. Gen. Laws ch. 218, § 21 and Uniform Small Claims Rules)

I. PARTIES & SERVICE INFORMATION

1. Plaintiff(s):
   • Name: [PLAINTIFF FULL LEGAL NAME]
   • Address: [STREET, CITY, STATE, ZIP]
   • Telephone / Email: [CONTACT INFORMATION]

2. Defendant(s):
   • Name: [DEFENDANT FULL LEGAL NAME]
   • Address: [STREET, CITY, STATE, ZIP]

3. Plaintiff’s Counsel (if any):
   • Name/Firm: [ATTORNEY NAME & BBO #]
   • Address: [ADDRESS]
   • Telephone / Email: [CONTACT INFORMATION]
   • Fax (optional): [FAX]

II. JURISDICTION, VENUE & STATUTORY COMPLIANCE

4. This Court has subject-matter jurisdiction because the claim is for money damages in an amount not exceeding $7,000.00, exclusive of interest and costs, which is within the monetary limit for Massachusetts small-claims actions.

5. Venue is proper in this Division because:
   a. the Defendant resides or has its usual place of business here; or
   b. the transaction or occurrence giving rise to this claim took place here.

6. No party seeks equitable or injunctive relief, a jury trial, punitive damages, or any other remedy outside the scope of the Massachusetts Small Claims Act.

III. DEFINITIONS (as used in this Complaint)

“Agreement” – The contract, lease, invoice, or other legally enforceable instrument dated [DATE] that forms the basis of Plaintiff’s claim.

“Claim Amount” – $[SPECIFY], being the principal sum sought exclusive of statutory interest and allowable court costs.

“Small Claims Rules” – The Massachusetts Uniform Small Claims Rules in effect on the date this Complaint is filed.

IV. STATEMENT OF FACTS & BASIS OF CLAIM

7. On or about [DATE], Plaintiff and Defendant entered into the Agreement whereby Defendant agreed to [BRIEFLY DESCRIBE OBLIGATION – e.g., “pay Plaintiff $____ for goods delivered”].

8. Plaintiff fully performed, or was ready, willing, and able to perform, all conditions precedent under the Agreement.

9. Defendant breached the Agreement by [SPECIFY – e.g., “failing to pay the invoiced amount when due”].

10. As a direct and proximate result of Defendant’s breach, Plaintiff has sustained monetary damages in the Claim Amount.

V. DAMAGES

11. Plaintiff seeks:
    a. Principal: $[CLAIM AMOUNT]
    b. Statutory interest from [DATE] at the contract rate of ___ % or, if none, at the Massachusetts statutory rate.
    c. Court costs and such other monetary relief as the Court deems just and proper.

VI. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests that judgment be entered in Plaintiff’s favor and against Defendant for:

1. The Claim Amount of $[___];
2. Pre- and post-judgment interest as allowed by law;
3. Court costs; and
4. Such other and further monetary relief as the Court deems just and proper.

VII. NOTICE REGARDING APPEAL RIGHTS

Pursuant to Uniform Small Claims Rule 7, any party aggrieved by the decision of the Clerk-Magistrate may, within ten (10) days after receipt of the notice of judgment, file a written request for a trial de novo before a judge of this Court. The judge’s decision may thereafter be appealed to the Appellate Division in accordance with Rule 10.

VIII. VERIFICATION

I, [PLAINTIFF NAME], hereby verify under the pains and penalties of perjury that the facts stated in this Complaint are true to the best of my knowledge, information, and belief.

Date: [DATE]

____________________________________
[PLAINTIFF NAME]
(Plaintiff / Authorized Representative)

IX. SIGNATURE BLOCK

Respectfully submitted,

PLAINTIFF,
[PLAINTIFF FULL LEGAL NAME]

By: ________________________________
Name: [ATTORNEY NAME], Esq. (BBO #_____)
Title/Firm: [LAW FIRM NAME]
Address: [ADDRESS]
Phone: [PHONE] | Email: [EMAIL]
Attorney for Plaintiff

X. CERTIFICATE OF SERVICE

I certify that on [DATE], I caused a true and correct copy of this Small Claims Complaint to be served in accordance with Uniform Small Claims Rule 3 by:

☐ Clerk-Magistrate mailing (default rule) or
☐ Constable/Sheriff personal service

upon:

• Defendant at [DEFENDANT ADDRESS]

________________________________
[ATTORNEY / PLAINTIFF SIGNATURE]