<?xml version="1.0" encoding="UTF-8"?>
<payload:NewFormA 
xmlns:payload="http://paymentorder.justice.eu/Payload/V3_0" 
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" 
xsi:schemaLocation="http://paymentorder.justice.eu/Payload/V3_0 Payload.xsd">

		<OriginatorMessageId>R123456-2010</OriginatorMessageId>
		<ResponsePDF>false</ResponsePDF>
		<CourtId>008</CourtId>

<payload:Formsheet_A>
  
  <Party id="p0001">
    <Address id="a0001">      
        <Country>DE</Country>
        <City>Berlin</City>
        <PostalCode>10365</PostalCode>
        <Street>Wolfengasse</Street>
        <StreetNumber>11</StreetNumber>
    </Address>    
 	<Communication id="c0001">
        <Entry>020 4444 5555</Entry>
        <IdentifierOfMedia>02</IdentifierOfMedia>
        <KindOfMedia>01</KindOfMedia>
      </Communication>          
	  <CorporateName>Tierhaltungs-GmbH</CorporateName>
	   <Type>02</Type>	  
      <PartyRole id="r0001">
        <Role>02</Role>
      </PartyRole>
     <Profession>Tierhalter</Profession>      
     
    </Party>
  
   <Party id="p0002">
      <Address id="a0002">
        <Country>AT</Country>
        <City>Wien</City>
        <PostalCode>1010</PostalCode>
        <Street>Albertgasse</Street>
        <StreetNumber>12</StreetNumber>
      </Address>
      <AsRepresentative id="ar00001">
      	<KindOfRelationship>01</KindOfRelationship>
        <Represented ref="p0003"/> 
      </AsRepresentative>
      <Communication id="c0002">
        <Entry>01 4444 555</Entry>
        <IdentifierOfMedia>02</IdentifierOfMedia>
        <KindOfMedia>01</KindOfMedia>
      </Communication>
      <Communication id="c0003">
        <Entry>albert@rechtsanwalt-advokat.at</Entry>
        <IdentifierOfMedia>02</IdentifierOfMedia>
        <KindOfMedia>03</KindOfMedia>
      </Communication>     
      <Identifier>R123456</Identifier>
      <FirstName>Albert</FirstName>      
      <Name>Advokat</Name>
      <Type>01</Type> 
      <PartyRole id="r0002">
        <Role>03</Role>
      </PartyRole>
     <Profession>Rechtsanwalt</Profession> 
      <Title>Dr.</Title>      
    </Party>
    
     <Party id="p0003">
      <Address id="a0003">
        <Country>AT</Country>
        <City>Wien</City>        
        <PostalCode>1010</PostalCode>
        <Street>Mustergasse</Street>
        <StreetNumber>1</StreetNumber>
      </Address>
      <Communication id="c0004">
        <Entry>01 111 222 333</Entry>
        <IdentifierOfMedia>02</IdentifierOfMedia>
        <KindOfMedia>01</KindOfMedia>
      </Communication>
      <FirstName>Franz</FirstName>
      <Name>Mustermann</Name>
      <Type>01</Type>
      <PartyRole id="r0003">
        <Role>01</Role>
      </PartyRole>
     <Profession>Zoohändler</Profession>      
      <Title>Dipl.Ing.</Title>      
    </Party> 
  
   <ConsumerContract>false</ConsumerContract>

    <CountryOfClaimant>AT</CountryOfClaimant>
    <CountryOfCourt>AT</CountryOfCourt>
    <CountryOfDefendant>DE</CountryOfDefendant>
    <KindOfPayment>03</KindOfPayment>

  <AmountOfTotalClaim>50000.0</AmountOfTotalClaim>
  <CurrencyOfTotalClaim>EUR</CurrencyOfTotalClaim>
  
   <ApplicationConfirmation id="ac0001">
   	  <CorporateName>Firma</CorporateName>
      <CityOfSignature>Wien</CityOfSignature>
      <DateOfSignature>2010-03-10</DateOfSignature>
    </ApplicationConfirmation> 
    
     <Claim id="cl0001">
      <Amount>7000.0</Amount>
      <BaseOfClaim>01</BaseOfClaim>
      <Circumstance>30</Circumstance>
      <DateFrom>2010-01-12</DateFrom>
    </Claim>
    <Claim id="cl0002">
      <Amount>43000.0</Amount>
      <BaseOfClaim>01</BaseOfClaim>
      <Circumstance>30</Circumstance>
      <DateFrom>2010-01-10</DateFrom>
    </Claim>

   <Cost id="co0001">
      <Amount>1300.0</Amount>
      <Currency>EUR</Currency>
	  <Explanation>Rechtsanwaltskosten</Explanation>      
      <KindOfCost>02</KindOfCost>      
    </Cost>
    <Cost id="co0002">
      <KindOfCost>01</KindOfCost>
    </Cost>
  
    <Evidence id="ev0001">     
      <Date>2010-01-12</Date>
      <Description>Re. Nr. 1870/10</Description>
      <KindOfEvidence>01</KindOfEvidence>
       <Claim ref="cl0001"/>
    </Evidence>
    <Evidence id="ev0002">
      <Date>2010-01-10</Date>
      <Description>Re. Nr. 1789/10</Description>
      <KindOfEvidence>01</KindOfEvidence>
      <Claim ref="cl0002"/>
    </Evidence>
  
    <Interest id="in0001">
      <AmountRelevantForCalculation>43000.0</AmountRelevantForCalculation>     
      <DateFrom>2010-02-10</DateFrom>
      <Ground>02</Ground>
      <InterestRate>12.0</InterestRate>
      <Period>A</Period>
      <Claim ref="cl0001"/>
    </Interest>
    <Interest id="in0002">
      <AmountRelevantForCalculation>7000.0</AmountRelevantForCalculation>     
      <DateFrom>2010-02-12</DateFrom>
      <Ground>02</Ground>
      <InterestRate>12.0</InterestRate>
      <Period>A</Period>
       <Claim ref="cl0002"/>
    </Interest>
  
   <Jurisdiction id="j0001">
      <Reason>02</Reason>
    </Jurisdiction>
     
    <payload:MeansOfCollectionAccount id="mo0002"> 
      <AccountHolder>Dr. Max Mustermann</AccountHolder>
      <BIC>AYMSAT31</BIC>
      <IBAN>AT50390500000000987654</IBAN>      
    </payload:MeansOfCollectionAccount>
    <payload:MeansOfDepositAccount id="mo0001"> 
      <AccountHolder>Dr. Albert Advokat</AccountHolder>
      <BIC>BAWAATWW</BIC>
      <IBAN>AT671400000987654321</IBAN>
    </payload:MeansOfDepositAccount>

    <RejectionOfTransfer id="re0001">
      <CityOfSignature>Wien</CityOfSignature>
      <DateOfSignature>2010-03-10</DateOfSignature>
    </RejectionOfTransfer>
    
</payload:Formsheet_A>
</payload:NewFormA>