Field 1: Insert the county where you are bringing the action.

Field 2: Print the Plaintiff's name.

Field 3: Insert the index number assigned to the case.

Field 4: Print the Defendant's name.

Field 5: List the state and county where either the Plaintiff or the attorney for the Plaintiff signed this document.

Field 6: Check the appropriate boxes.

Field 7: Check the appropriate box.

Field 8: Insert the date that the document was completed if signed by an attorney. If the Plaintiff is self-represented, the document must be signed and notarized before a notary public.