District of Columbia small claims
How to fill out DC's Statement of Claim (CV-471)
Official form: CV-471 — Statement of Claim (Small Claims) · Walkthrough written against CV-471/Dec. 2018 (Small Claims Form 11)
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Get the official CV-471 from the court's site →Link verified 2026-07-04. If it has moved, the court's forms index and clerk's office will have the current version — verify with the court before filing.
What this form is
The Statement of Claim — form CV-471, "Small Claims Form 11" — starts a case in the Small Claims and Conciliation Branch of the Superior Court of the District of Columbia. The branch sits in Court Building B at 510 4th Street NW, Room 120, and its address and phone number are printed in the form's header. A Small Claims Information Sheet is filed along with it.
DC small claims handles money claims up to $10,000. The CV-471 is a sworn form: the claim ends in an oath that the statement is "a just and true statement of the amount owing by the defendant to plaintiff, exclusive of all set-offs and just grounds of defense," signed before a notary public or deputy clerk, with a place for the notary seal.
The packet has three parts: the Statement of Claim itself, a page of Instructions to Defendants (which explains, among other things, that a trained mediator meets with the parties before any small claims trial), and a Notice page with the same caption that tells the defendant the claim amount and the hearing date — the hearing information is completed by the Clerk of the Court, not by you.
The form, field by field
What each part of the form asks for, in the form's own order. These are descriptions of the questions — what to answer depends on facts only you know, and the court clerk or the form's own instructions are the authoritative sources.
The caption
Case No., Plaintiff(s), Defendant(s), addresses, zip codes, phone number
The case number is assigned by the clerk. The caption asks for each side's name and address with zip code, plus the plaintiff's phone number — the defendant's address is where the claim and notice are served.
Statement of Claim and Request for Relief
Statement of Claim (nine blank lines)
The claim in your own words — what happened and why the defendant owes the amount claimed. This is the description the court and the defendant read.
Request for Relief (two lines)
What you are asking the court to order — typically the dollar amount claimed. The Notice page repeats the sum both in words and figures.
The oath and signatures
"DISTRICT OF COLUMBIA, ss:" sworn statement
Pre-printed oath text: the named person, "being first duly sworn on oath says the foregoing is a just and true statement of the amount owing by the defendant to plaintiff, exclusive of all set-offs and just grounds of defense."
Plaintiff/Agent signature block — sign and print name, title, address, email, phone
The person swearing to the claim signs and prints their name; the title line covers agents signing for a business plaintiff.
"Subscribed and sworn to before me this ___ day of ___, 20___" — notary public or deputy clerk, seal
The jurat: a notary public or a deputy clerk completes the date and signs, with a marked space for the notary seal. Signing at the clerk's office when filing lets the deputy clerk administer the oath.
Attorney for Plaintiff (sign and print name), Bar No., address, email, phone
Completed only when an attorney files for the plaintiff; self-represented plaintiffs leave it blank.
The Notice page
Notice — claim amount in words and figures, hearing date, clerk's signature
A page with the same caption notifying the defendant that a claim has been made "in the sum of ___ dollars ($___), as shown by the attached Statement of Claim," and that the court will hold a hearing on a stated date in the Small Claims and Conciliation Branch. The hearing date and the signature line belong to the Clerk of the Court or deputy clerk. The page carries translated notices in Spanish, Chinese, French, Korean, Vietnamese, and Amharic with the court's interpreter phone line.
Instructions to Defendants
The defendant-facing back page
Pre-printed information for the person being sued: appear on the hearing date or risk a default judgment for the amount demanded; a trained mediator meets with the parties before any case goes to trial; lawyer referral resources (Legal Aid Society, Legal Counsel for the Elderly, Tzedek DC, and others); and the Small Claims Resource Center hours. It is part of the served packet, not something you fill out.
Common reasons clerks reject this form
Clerks bounce filings for mechanical, fixable reasons. These are the patterns that come up with this particular form:
- ⚠Filing an unsworn form — the CV-471's oath must be signed before a notary public or deputy clerk, and the jurat and seal block completed; without them the form is incomplete.
- ⚠Claiming more than $10,000 — that is the Small Claims and Conciliation Branch's limit, and larger claims belong in the Civil Division's regular track.
- ⚠Omitting the Small Claims Information Sheet — the branch requires it to be filed with the Statement of Claim.
- ⚠Leaving the caption or the Notice-page caption incomplete — the Notice travels to the defendant with the claim, and both need the parties and addresses with zip codes.
- ⚠Writing a hearing date on the Notice — the date and the clerk's signature are entered by the court when the case is docketed.
- ⚠Leaving the amount blanks on the Notice page empty — the form states the sum both in words and in figures.
What filing costs, and where it happens
Filing costs in the Small Claims Branch are tiered by claim amount. The court's own Small Claims Information Handbook lists $5.00 for claims of $500 or less, $10.00 for claims over $500 up to $2,500, and $45.00 for claims over $2,500 up to $5,000 — that handbook edition predates the branch's current $10,000 ceiling, so the tier for larger claims (and any updated figures) is one to confirm directly. Service costs are separate and depend on the method. The Small Claims Clerk's Office at (202) 879-1120 quotes the current amounts — verify before filing.
You file at the Small Claims and Conciliation Branch, 510 4th Street NW, Court Building B, Room 120 — the address printed on the form itself; DC Superior Court also operates e-filing for small claims. Filing in person lets a deputy clerk administer the oath the form requires. After filing, the clerk completes the Notice with the hearing date, the defendant is served, and — as the form's instructions explain — a trained mediator meets with both parties before any trial is held.
Published fees and court locations for your county are in our District of Columbia small claims guide and the court directory. Fees change — verify the current amount with the clerk before filing.
Frequently asked questions
Where do I get the CV-471?
From dccourts.gov — the official fillable PDF is free and linked on this page, and the form is also available in Spanish from the court. The clerk's office in Court Building B provides paper copies.
Does the Statement of Claim have to be notarized?
It must be sworn — signed before either a notary public or a deputy clerk, who completes the subscribed-and-sworn block (with a seal space for notaries). Signing at the clerk's counter when filing takes care of it without a separate notary visit.
How much can I sue for in DC small claims?
Up to $10,000 in the Small Claims and Conciliation Branch. Larger claims go to the Civil Division's regular civil track.
What does it cost to file?
A tiered filing cost — the court's handbook lists $5, $10, or $45 depending on the claim amount, plus service costs. The Small Claims Clerk's Office confirms the current figures for your claim; verify before filing.
What happens after I file?
The clerk dockets the case and completes the Notice with a hearing date, the defendant is served with the Statement of Claim and Notice, and both parties appear on that date. The form's instructions explain that a trained mediator meets with the parties first; if no settlement is reached, the case can be scheduled for trial. If the defendant does not appear, the instructions warn that a default judgment may be entered for the amount demanded.
Related guides
Form link verified: 2026-07-04. Reviewed against our Editorial Standards.
This is general information to help you understand the form — not legal advice, and not a substitute for advice from a licensed attorney about your specific situation. Courts revise forms, fees, and procedures; the court's own instructions and your court clerk are the authoritative sources. Always verify with the court before filing.