ONTARIO. |. | |Superior Court of Justice. |Request to C

ONTARIO
Superior Court of Justice Request to Clerk
Form 9B Ont. Reg. No.: 258/98
Superior Court of Justice SC-00-12345-19.
Small Claims Court Claim No.
74 Woolwich St, Guelph, ON N1H 3T9,
Canada
Address
Phone number
BETWEEN
Manuel Lopez
Plaintiff(s)
and
Anna Johnstone and Belinda Cosmo
Defendant(s)
TO THE CLERK OF THE Ontario SMALL CLAIMS COURT:
(Name of Small Claims Court location)
My name is Stanley Kostas and I request that the clerk of the court:
(Name of party/representative)
(Check appropriate box(es).)
note defendant(s) Anna Johnstone and Belinda Cosmo
(Name of defendant(s))
in default for failing to file a Defence (Form 9A) within the prescribed time period [R. 11.01(1)].
schedule an assessment hearing (all defendants have been noted in default) [R. 11.03(2)(b)].
schedule a terms of payment hearing because I dispute the defendant’s proposed terms of payment
contained in the Defence (Form 9A) [R. 9.03(3)].
schedule a trial [R. 16.01(1)(b)].
accept payment in the amount of $ 1977.50 into court
(Amount)
according to an order of the court, dated , 20 .
for a person under disability according to an order or settlement dated
, 20 [R. 4.08(1)].
pursuant to the attached written offer to settle, dated , 20 [R. 14.05(2)].
according to the following legislation:
Small Claims Act, 1996 .
(Name of statute or regulation and section)
SCR 4-9-11-14-16-9B (January 23, 2014) CSD

Les formules des tribunaux sont affichées en anglais et en français sur le site
www.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des
formats accessibles.
SCR 4-9-11-14-16-9B (January 23, 2014) CSD

FORM 9B PAGE 2 SC-00-12345-19.
Claim No.
Other: (Specify.)
, 20
(Signature of party or representative)
CAUTION: To obtain an assessment of damages, all defendants must be noted in default. If one or
more defendants has filed a defence, the matter must proceed to a settlement conference.
To bring a motion in writing for an assessment of damages, file a Notice of Motion and
Supporting Affidavit (Form 15A). You can get forms at court offices or online at
www.ontariocourtforms.on.ca.
SCR 4-9-11-14-16-9B (January 23, 2014) CSD