Free Form 10 - Iowa

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September 2004

SMALL CLAIMS FORMS

Ch 3, p.9

Form 3.10: Original Notice - Action of Replevin.
September 2004

IN THE DISTRICT COURT OF IOWA IN AND FOR ______________________ COUNTY, IOWA (Small Claims Division) Plaintiff(s) (Name) (Address) (Name) (Address) vs. Defendant(s) (Name) (Address) (Name) (Address) TO THE ABOVE-NAMED DEFENDANT(S): YOU ARE HEREBY NOTIFIED that the above-named plaintiff(s) demand(s) possession of property described as: (insert description)
(1) The actual value of the property is $ _________________ (If more than one item is involved, separate values must be stated for each item.) (May not exceed $5,000 in total value.) (2) Plaintiff(s) is (are) entitled to immediate possession because (check one): Plaintiff(s) own(s) the property; Plaintiff(s) has (have) a security agreement for the property (copy attached) providing that plaintiff(s) is (are) entitled to seize possession on default, and that default(s) as follows has (have) occurred; (State other grounds). (a) That the property is not in the possession of the defendant(s) under court order or judgment; or (3) (b) That property was taken by the defendant(s) under a court order or judgment but is improperly held, being exempt from such seizure because: (state basis for exemption). (4) That to the best belief of the plaintiff(s) the property is being held by the defendant(s) because: (state facts constituting the defendant's(s') alleged reason for detaining the property). (5) That the plaintiff(s) is (are) entitled to damages for such retention in the amount of $ ________________, based on: (state grounds of alleged damage).

ORIGINAL NOTICE (Action of Replevin) Small Claim No. _________________ Date Filed ______________________

UNLESS YOU APPEAR by completing and filing the attached appearance and answer form with the clerk of the court at ________________________ (exact address) in _________________ (city), Iowa ______ (zip code), within 20 days after service of this original notice upon you, judgment shall be rendered against you upon plaintiff's(s') claim together with interest and court costs.

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Ch 3, p.10

SMALL CLAIMS FORMS

September 2004

Original Notice - Action of Replevin (cont'd)
IF YOU DENY THE CLAIM AND APPEAR by filing the attached appearance and answer within 20 days after service of this original notice upon you, you will then receive notification from the clerk's office of the place and time assigned for hearing.

__________________________________________________ __________________________________________________ Plaintiff(s)

STATE OF IOWA COUNTY OF ___________________

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I (We), _________________________________________________, do hereby swear or affirm that the above and foregoing statements are true and correct as I (we) verily believe. __________________________________________________ (Signature(s) of affiant(s)) Subscribed and sworn to before me by _______________________________________________________, on this _________________ day of _____________, 20 _____. __________________________________________________ Notary Public

[Report March 10, 1987, effective July 1, 1987; Court Order November 25, 1998; November 9, 2001, effective Febru- ary 15, 2002; June 14, 2002, effective July 1, 2002]
September 2004