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Statement Of Claim - Auto Negligence - Florida

Statement Of Claim - Auto Negligence Form. This is a Florida form and can be used in Civil-Small Claims Santa Rosa Local County .
 Fillable pdf Last Modified 2/28/2005
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IN THE COUNTY COURT IN AND FOR SANTA ROSA COUNTY, FLORIDA Plaintiff(s) vs. CASE No. Defendant(s) STATEM ENT OF CLAIM AUTO NEGLIGENCE The Plaintiff(s) sues the defendant(s) and says: On or about ,in the vicinity of , on apublic highway in Santa Rosa County, Florida, plaintiffs motor vehicle, being operated by ,collided with defendantsmotor vehicle, being operated by , and the collisionwith plaintiffs vehicle was caused by the negligent and careless operation of defendants vehicle, wherebyplaintiffs vehicle was damaged and depreciated in value. WHEREFORE, Plaintiff(s) demands judgment in the sum of $ andCourt Costs in the amount of $____________________________. STATE OF FLORIDA, SANTA ROSA COUNTY ______________________________________being first duly sworn on an oath says the foregoing is a just andtrue statement of the amount owed by defendant(s) to plaintiff(s), exclusive of all set-offs and just grounds ofdefense: MARY M. JOHNSON, CLERK OF COURTS Plaintiff(s) or Attorney for Plaintiff(s)Subscribed and sworn to before me this_________________day of , 20 . Notice: This document requires an official Court summons Notary Public or Deputy Clerk with signature and the official court seal affixed thereto.
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