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2. STATEMENT OF RIGHTS AND WAIVER - SMALL CLAIMS
4. STATE OF MICHIGAN
   THE 60TH DISTRICT COURT - SMALL CLAIMS DIVISION
6. Case Number:*
8. Plaintiff name:*
10. Defendant name:*
12. I understand that I have the right to demand that this case be removed to the District Court for any further proceedings; and that if I agree to have this case tried in the Small Claims Division, I have waived my right to council , my right to trial by jury, the right to recover more than the applicable jurisdictional amount as prescribed by Section 8401, and any right of the appeal, except as otherwise provided by law pursuant to MCLA 600.8412, (an action first heard by a magistrate).
14. I am the Plaintiff / Defendant in the above mentioned action. (Select one)*

    1. Plaintiff
    2. Defendant
16. Plaintiff name*
17. by
    If applicable
19. Defendant name*
20. by
    If applicable
22. Date*
    Date
24. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature*
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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