IN THE COUNTY COURT, EIGHTH JUDICIAL CIRCUIT, IN AND FOR ALACHUA COUNTY, FLORIDA 201 East University Avenue - Post Office Box 600 Gainesville, Florida 32602 (352) 374-3636 PLAINTIFF Case Number: Address Division: City, State Zip Code Phone -vs- DEFENDANT DEFENDANT Address Address City, State Zip Code City, State Zip Code Phone Phone STATEMENT OF CLAIM (MONEY LENT) Plaintiff(s), sue(s) Defendant(s), , and alleges: 1. This is an action for damages which do not exceed the sum of $5,000.00 exclusive of costs, interest and attorneys fees. There is now due, owing and unpaid from Defendant(s) to Plaintiff(s), the sum of $ for money lent by Plaintiff(s) to Defendant(s) on, , . with interest thereon since , . If a Defendant is to be served with process outside the State of Florida, see Exhibit "A" attached. WHEREFORE, Plaintiff(s) demand(s) Judgment for damages against Defendant(s) in the amount of $ principal, plus $ interest, plus $ court costs. PLAINTIFF(s) Statement of Claim - Money Lent.doc