Small Claims Complaint

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

New York requires the use of official court form CIV-SC-50 (Statement of Claim) 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 nycourts.gov.
Do not file this document directly with the court.

SMALL CLAIMS COMPLAINT

(New York – Small Claims Part)

DOCUMENT HEADER

COURT: [___] SMALL CLAIMS PART  
COUNTY: [___]  
ADDRESS: [Court’s street address, city, state, zip]  

-------------------------------------------------------------  
PLAINTIFF:  [Full Legal Name]            INDEX/CASE NO.: ________  
ADDRESS:    [Street, City, State, Zip]   (Assigned by Clerk)  

                        – against –  

DEFENDANT:  [Full Legal Name]  
ADDRESS:    [Street, City, State, Zip]  
-------------------------------------------------------------  

SMALL CLAIMS COMPLAINT  

Effective Date of Filing: [MM/DD/YYYY]
Governing Law: State of New York
Forum Selection: Small Claims Part (as captioned above)
Jury Trial: Not available pursuant to court rules and/or parties’ election

1. PARTIES

1.1 Plaintiff. [Plaintiff Name] (“Plaintiff”) is an individual/business entity residing/located at [address].

1.2 Defendant. [Defendant Name] (“Defendant”) is an individual/business entity residing/located at [address] and is subject to the personal jurisdiction of this Court.

2. JURISDICTION & VENUE

2.1 Monetary Jurisdiction. The amount in controversy does not exceed $[___], which is within the monetary limit for this Court’s Small Claims Part.

2.2 Subject-Matter Jurisdiction. This claim seeks only monetary damages and therefore falls within the scope of New York small-claims practice.

2.3 Venue. Venue is proper because (a) Defendant resides, is employed, or regularly transacts business in this county, and/or (b) the cause of action arose in this county.

3. STATEMENT OF FACTS

3.1 [Concise, numbered factual allegations describing the transaction/occurrence]
  a. On or about [date], Plaintiff and Defendant entered into [describe agreement/transaction].
  b. Defendant [describe wrongful conduct—e.g., failed to pay, delivered defective goods, etc.].
  c. Plaintiff duly performed all obligations or was excused from performance.
  d. As a direct result, Plaintiff has sustained damages in the amount set forth below.

4. CAUSE(S) OF ACTION

Count 1 – [e.g., Breach of Contract / Property Damage / Goods Sold & Delivered]

4.1 Plaintiff repeats and realleges ¶¶ 1–3 as if fully set forth herein.

4.2 Defendant owed Plaintiff a duty/obligation to [state duty].

4.3 Defendant breached said duty by [specific act/omission].

4.4 Plaintiff suffered monetary damages of $[___] as a foreseeable and direct result.

5. DAMAGES

5.1 Principal Amount ……..................................................... $[___]
5.2 Pre-Judgment Interest (if legally recoverable) …………… $[___]
5.3 Court Costs & Disbursements (to date) ……………………… $[___]
5.4 TOTAL SOUGHT (not to exceed limit) ………………………… $[___]

6. DEMAND FOR JUDGMENT

WHEREFORE, Plaintiff respectfully demands judgment against Defendant for:

a. Monetary damages in the total sum of $[___] or such amount as is proven at trial, together with applicable interest;
b. Statutory court costs and disbursements; and
c. Such other and further relief as the Court deems just and proper within the limited jurisdiction of this Court.

7. VERIFICATION

STATE OF NEW YORK )
) ss.:
COUNTY OF ☐ )

I, [Plaintiff Name], being duly sworn, depose and say: I am the Plaintiff in the within action; I have read the foregoing Complaint and know the contents thereof; the same is true to my own knowledge, except as to the matters therein stated to be alleged on information and belief, and as to those matters I believe them to be true.

Date: [MM/DD/YYYY]

______________________________
[PLAINTIFF NAME]

Sworn to before me this ___ day of __________, 20__

______________________________
Notary Public

8. CERTIFICATE OF MAILING / SERVICE

I certify that on [MM/DD/YYYY] I served a true copy of this Complaint (with exhibits) on Defendant at the above-stated address by [method approved by court—e.g., certified mail, return receipt requested], and I have retained proof of mailing for filing.

______________________________
[Name & Signature of Person Serving]

9. NOTICE OF APPEAL RIGHTS

Plaintiff is advised that any appeal from a final judgment in this matter must be taken within thirty (30) days of service of the judgment with notice of entry, limited to review of questions of law. See applicable court rules.

10. ATTORNEY INFORMATION (IF APPLICABLE)

Attorney for Plaintiff: [Law Firm Name]
Address: [Street, City, State, Zip]
Telephone: [___-___-____]
Email: [___]
Attorney Registration No.: [___]

END OF COMPLAINT

[// GUIDANCE – FILING CHECKLIST:

1. Confirm monetary limit compliance.
2. Complete all placeholders.
3. Attach supporting exhibits and label sequentially.
4. File original with Clerk; pay filing fee.
5. Follow court-specific service and proof requirements.]