Rule 4 Complaint

A complaint shall be in writing and signed by the plaintiff or his or her attorney, if any. It shall also: (a) state the names of the parties, the nature and basis of the claim, and the nature and amount of the relief sought; (b) warn the defendant to file a written answer with the clerk of the court, and to serve a copy to the plaintiff or his or her attorney, within 30 days after service of the complaint upon him; (c) warn the defendant that failure to file an answer may result in a default judgment being entered against him; (d) recite the address of the plaintiff or his or her attorney, if any; and (e) contain a proof of service form which shall be completed by the person serving the defendant. No separate summons is required.

COMPLAINT - FORM ___________ Court of ___________, Arkansas _________________________, Plaintiff vs. No. _______________________ ______________________________________, Defendant Plaintiff's Address: ________________________ Defendant’s Address: ________________________ Nature of Claim: _________________________ Nature and Amount of Relief Claimed: ____________________________ ___________________________________________ Date Claim Arose: ________________________ Factual Basis of Claim: ________________________ Plaintiff's Attorney, if any, and Address: ____________________________ ____________________________ ____________________________ ___________________________________ [Signature of Attorney, if any, or of Plaintiff]

SUMMONS AND NOTICE TO DEFENDANT

You are hereby warned to file a written answer with the clerk of the court within 30 days after the date that you receive this complaint and to send a copy to the plaintiff or to his or her attorney. If you do not file an answer within 30 days, or if you fail to file an answer, a default judgment may be entered against you. ______________________________ [Signature of Clerk or Judge]

PROOF OF SERVICE STATE OF ARKANSAS CITY OF _____________________ I, _______________________, hereby certify that I served the within complaint on the defendant, ________________________, at o'clock _____.m. on ____________ 2_____, by [state method of service]. _____________________________ [Signature and Office, if any] Subscribed and sworn to before me this _____ day of _________ 2_____, [To be completed if service is by someone other than sheriff or constable.] ____________________________ Notary Public or Court Clerk My Commission Expires:___________