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Statement Of Claim (Sample And Form) - Florida

Statement Of Claim (Sample And Form) Form. This is a Florida form and can be used in Small Claims Citrus Local County .
 Fillable pdf Last Modified 6/27/2013
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EXAMPLE IN THE COUNTY COURT IN AND FOR CITRUS COUNTY FIFTH JUDICIAL CIRCUIT OF FLORIDA CASE NO.__________________ YOUR NAME/BUSINESS NAME ADDRESS CITY, STATE, ZIP TELEPHONE NUMBER Plaintiff(s) -vsPERSON/BUSINESS NAME ADDRESS OR POE CITY, STATE, ZIP TELEPHONE NUMBER Defendant(s) _________________________________/ STATEMENT OF CLAIM The plaintiff(s) sues defendant(s) and alleges: This is an action for damages within the jurisdiction of this court which do not exceed the amount of $5,000.00 exclusive of costs, interest and attorney's fees. Said plaintiff(s) claims the amount of $_______________________as being due from said defendant(s) and alleges as the basis of such suit: BRIEF STATEMENT WHY YOU ARE FILING THIS CASE. DO NOT INCLUDE COURT COSTS IN THE AMOUNT YOU ARE SUING FOR. WHEREFORE, plaintiff(s) demands judgment for damages against defendant(s). STATE OF FLORIDA COUNTY OF CITRUS The undersigned, being first duly sworn on oath, states the foregoing is a just and true statement of the amount owing by the above named defendant(s) to the said plaintiff(s), exclusive of all set-offs and just grounds of defense. Affiant further states that the defendant(s) is not in the military service of the United States, and that the action has been brought in the county in which venue is proper, pursuant to Chapter 47, Florida Statutes. ______________________________________________________ AFFIANT Subscribed and sworn before me this _________ day of _________________________, 20_____. ANGELA VICK CLERK OF THE COURT Angela Vick, Clerk of the Circuit Court 110 N. Apopka Avenue, Room 101 Inverness, Fl. 34450-4299 (352) 341-6424 By:_____________________________________________ Deputy Clerk Or:______________________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com IN THE COUNTY COURT IN AND FOR CITRUS COUNTY FIFTH JUDICIAL CIRCUIT OF FLORIDA CASE NO.__________________ -vs- Plaintiff(s) Defendant(s) _________________________________/ STATEMENT OF CLAIM The plaintiff(s) sues defendant(s) and alleges: This is an action for damages within the jurisdiction of this court which do not exceed the amount of $5,000.00 exclusive of costs, interest and attorney's fees. Said plaintiff(s) claims the amount of $_______________________as being due from said defendant(s) and alleges as the basis of such suit: WHEREFORE, plaintiff(s) demands judgment for damages against defendant(s). STATE OF FLORIDA COUNTY OF CITRUS The undersigned, being first duly sworn on oath, states the foregoing is a just and true statement of the amount owing by the above named defendant(s) to the said plaintiff(s), exclusive of all set-offs and just grounds of defense. Affiant further states that the defendant(s) is not in the military service of the United States, and that the action has been brought in the county in which venue is proper, pursuant to Chapter 47, Florida Statutes. ______________________________________________________ AFFIANT Subscribed and sworn before me this _________ day of _________________________, 20_____. ANGELA VICK CLERK OF THE COURT Angela Vick, Clerk of the Circuit Court 110 N. Apopka Avenue, Room 101 Inverness, Fl. 34450-4299 (352) 341-6424 By:_____________________________________________ Deputy Clerk Or:______________________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com
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