Statement Of Claim

IN THE COUNTY COURT IN AND FOR DUVAL COUNTY, FLORIDA CASE NUMBER: DIVISION: Name: __________________________________ Address: _________________________________ Telephone:_______________________________ ,Plaintiff VS. Name:__________________________________ Address:_________________________________ Telephone:________________________________, Defendant Statement of Claim The Plaintiff _____________________________ sues the Defendant __________________________and alleges: 1. This is an action for damages which do not exceed the sum of $5,000, exclusive of interest and costs. 2._____________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ WHEREFORE Plaintiff ________________demands judgment in the sum of $________________. ________________________________ (Print name) ________________________________ (Signature) American LegalNet, Inc. www.FormsWorkFlow.com