Full Name of Party Filing Document

Mailing Address (Street or Post Office Box)

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Telephone

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IN THE DISTRICT COURT FOR THE 		 JUDICIAL DISTRICT
FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF 				

						,
		Plaintiff(s),
	vs.

						,
		Defendant(s).
	
Case No. 					

MEMORANDUM OF COSTS

I certify:
That I am the above named Plaintiff; that to the best of my knowledge and belief the items of costs and in this action are correct and necessarily incurred in this action.
That I have read the Complaint filed in this action and know the contents; that the allegations are true to the best of my knowledge; that the Defendant(s) is/are not minor(s) nor incompetent; that the Defendant(s) was/were properly served, and now owe to the Plaintiff(s) the following amount:
		FILING FEE		$		
	SERVICE OF PROCESS	$		
	OTHER			$		
			           TOTAL $		

 CERTIFICATION UNDER PENALTY OF PERJURY

I certify under penalty of perjury pursuant to the law of the State of Idaho that the foregoing is true and correct.

Date: 				

Typed/printed 		 				 	Signature