Florida > Local County > Hernando > Small Claims
Statement Of Claim - Florida
| Statement Of Claim Form. This is a Florida form and can be used in Small Claims Hernando Local County . |
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IN COUNTY COURT, HERNANDO COUNTY, FLORIDA COUNTY CIVIL CASE NO. BROOKSVILLE, FLORIDA , Plaintiff(s) -vs- Address , Defendant(s) Address Statement of Claim The Plaintiff(s) sue(s) the Defendant(s) and states: AMOUNT OF CLAIM: FILING FEE: SHERIFF FEE: TOTAL: This is an action for damages less than $5,000.00 exclusive of costs, interest and attorneys fees. The undersigned, being by me first duly sworn, says that he/she is the Plaintiff(s) Agent for Plaintiff(s) , Attorney for Plaintiff(s) that the foregoing is a just and truestatement of the amount owing by the above named Defendant(s) to said Plaintiff(s), exclusive of all set-offs and just grounds for defense. Plaintiff(s) state(s) that the suit initiated by the forgoing statement of claim is broughtin good faith and with no intention to annoy the above named Defendant(s); and, further says that the Defendant(s) is/are not in the military service of the United States. Wherefore, plaintiff(s) demand(s) judgment for damages against the defendant(s). Subscribed and sworn to before me this day of , . Signature Deputy Clerk or Notary Public if signed outside of Clerks office KAREN NICOLAI Clerk of County Court Hernando County 20 N. Main Street, Room 248 Brooksville, FL 34601 Form 203 (StmtClm.wpd) 1-COURT COPY 2 - PLAINTIFFS COPY 3 - DEFENDANTS COPY 4 - DEFENDANTS COPY 062304
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