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Small Claims Court _________________________ County, Colorado

Court Address:

PLAINTIFF(S): ______________________________________________
Address: ____________________________________________________
City/State/Zip: ________________________________________________
Phone: Home _______________________ Work ___________________
v.
DEFENDANT(S): _____________________________________________
COURT USE ONLY
Address: ____________________________________________________
Case Number:
City/State/Zip: ________________________________________________
Phone: Home _______________________ Work ___________________
Division Courtroom
NOTICE OF NON-COMPLIANCE AND ORDER

Please take notice that (name of party) has failed to comply with the
terms of the order to compel delivery, compliance, or performance that was entered by the Court on
_______________________ (date) in the following manner:

I request that the Court schedule a hearing to determine the amount of damages or other remedies to be
imposed for the failure to comply with the judgment.
By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.
By checking this box, I am acknowledging that I have made a change to the original content of this form.

Date: ________________________________ _____________________________________


Signature

CERTIFICATE OF MAILING
I hereby certify that on __________________________ (date), I mailed a true and correct copy of the NOTICE
OF NON-COMPLIANCE AND ORDER, by placing it in the United States Mail, postage pre-paid to the parties at
the addresses listed above.

______________________________________________
Clerk of the Court/Deputy

ORDER
A hearing is set for __________________________ (date) to determine the amount of damages or other
remedies to be imposed by the Court for the failure to comply with the judgment. Failure to appear may result in
an imposition of damages or other remedies allowed by law.

Date: ____________________________ _____________________________________


JudgeMagistrate

JDF 249SC R3/18 NOTICE OF NON-COMPLIANCE AND ORDER

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