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Statement Of Claim Auto Collision With Medical Expenses - Florida
| Statement Of Claim Auto Collision With Medical Expenses Form. This is a Florida form and can be used in General Orange Local County . |
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IN THE COUNTY COURT OF THE NINTH JUDICIAL CIRCUIT OF FLORIDA ORANGE COUNTY, FLORIDA Case Number ____________________ Plaintiff(s) VS Defendant(s) STATEMENT OF CLAIM AUTO COLLISION WITH MEDICAL EXPENSES The above named Plaintiff(s) sue(s) the above named Defendant(s) for : 1. That on or about __________________________________, at: _____________________________________________________________________ City, ____________________, County, ________________, State, ______________ the defendant ____________________________________ willfully and/or recklessly and/or negligently drove a motor vehicle owned by ___________________________ against the motor vehicle of the plaintiff(s) thereby damaging the same, depreciating its market value, and causing plaintiff(s) to lose the value of its use during its repair. 2. Because of the facts stated in paragraph one (1) hereof, plaintiff(s) _______________________________________________ suffered painful bodily injuries requiring hospitalization and or medical treatment, for the reasonable cost of which plaintiff(s) became obligated to pay. And Plaintiff(s) claim(s) $ interest, court costs and attorney fees. damages not to exceed $5,000.00 exclusive of ______________________________ Plaintiff(s) American LegalNet, Inc. www.FormsWorkFlow.com
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