CIVIL CASE NUMBER
STATE OF SOUTH CAROLINA	)
)	IN THE MAGISTRATE’S COURT
COUNTY OF	)
)
)
PLAINTIFF	)
)
STREET ADDRESS	)
,	)
CITY, STATE ZIP	)
)
TELEPHONE	)
VS.	)	COMPLAINT
)
DEFENDANT(S)	)
)
STREET ADDRESS	)
,	)
CITY, STATE ZIP	)
)
TELEPHONE	)

I, , the plaintiff in this civil action do make the following claims:

1.	I believe the defendant, , is a resident of County, and resides at which is within Judge ’s magisterial jurisdiction or this Complaint is properly filed in County.

I make this complaint on the following:

(Attach supplement if necessary)

3.	I believe, because of the above information, that I am entitled to and do request a judgment for $ and/or other relief as below requested:

including any costs resulting in this action.

I state under penalty of perjury that the above is correct and truthful, except those based on my information and belief.

Dated:
Signature of Plaintiff (or his attorney)

SCCA/701 (Amended 05/08)

mbaughman

2008-05-06

Winkie Clark

County of Greenville