Ind. Porter Cnty. Small Claims Rules App. 1

SMALL CLAIMS RULES APPENDIX 1

STATE OF INDIANA ) IN THE PORTER SUPERIOR COURT

) SS:

COUNTY OF PORTER )

)

)

PLAINTIFF )

)

, I NDIANA

vs. ) CAUSE NO. 64D0 -

)

)

DEFENDANT )

LANDLORD COMPUTATION OF DAMAGES FORM

The Plaintiff(s)/Landlord, under the penalties for perjury states that the following

computations represent the damages incurred as a result of a breach of the lease agreement and/or

tenancy by the Defendant/Tenant:

[Ordinary wear and tear is not a compensable damage and will be subtracted by the Court in

many instances. Also, labor costs for cleanup by the Landlord are normally disfavored]

I. UNPAID RENT: MONTHS @ $ PER MONTH=$

LESS SECURITY DEPOSIT (if applicable) -$

Sub-Total Due $

II. DAMAGES TO PREMISES

1. Paint, cleaning products $

2. Physical damage to walls, etc. $

3. Removal of personal property $

4. OTHER $

5. OTHER $

Total Physical Damages $

GRAND TOTAL OF DAMAGES DUE $

This form can be utilized when requesting a default judgment

for damages, post-eviction, or as a summary exhibit at a contested trial or damages hearing.

Plaintiff must return this form personally or by first class mail to the Clerk=s Office on or before

seven (7) calendar days before the scheduled trial. Failure to timely return this claim form to the

Clerk=s Office may result in the granting of a continuance to the Defendant.

PLEASE SIGN: