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Statement Claim (Accident) Form. This is a Florida form and can be use in Alachua Local County.
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Tags: Statement Claim (Accident), Florida Local County, Alachua
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
IN THE COUNTY COURT OF THE EIGHTH JUDICIAL CIRCUIT,
IN AND FOR ALACHUA COUNTY, FLORIDA
:
JUDICIAL SUBPOENA
Plaintiff(s)
201 East University Avenue - Post Office Box 600
-against:
Gainesville Florida 32602
(352) 374-3636
:
Case No.:
:
PLAINTIFF
Defendant(s)Division:
:
......................................................
Address
City, State Zip Code
THE PEOPLE OF THE STATE OF NEW YORK
Phone
-vs- TO
DEFENDANT
DEFENDANT
Address
Address
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each ofCity, State Zip Code
you attend before
City, State Zip Code
,
the Honorable
at the
Court
located at
County of
Phone
Phone
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witnessCLAIM
STATEMENT in this action on the part of the
(Accident)
Plaintiff(s),
,
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
sue(s) the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Defendant(s),
and alleges:
result of your failure to comply.
1. This is an action for damages which do not exceed the sum of $5,000.00, exclusive of costs, interest and attorney’s
fees.
Witness, Honorable
, one of the Justices of the
Court in
2. On or about
in
being operated by
County,
day of
, 20
,
, in the vicinity of
County, Florida, a motor vehicle owned by must sign above and type name below)
,
(Attorney
was in a collision with a motor vehicle owned by
, being operated by
.
Attorney(s) for
3. The collision with Plaintiff’s vehicle was caused by the negligent and careless operation of Defendant’s vehicle,
whereby Plaintiff’s vehicle was damaged and depreciated in value.
Office and P.O. Address
If a Defendant is to be served with process outside the State of Florida, see Exhibit “A”, attached.
$
WHEREFORE, Plaintiff(s) demands Judgment for damages against Defendant(s) in the amount of
Telephone No.:
, plus $
Court costs.
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
PLAINTIFF(S)
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Statement of Claim - Accident.doc
