IN THE COUNTY COURT IN AND FOR BAY COUNTY, FLORIDA Small Claims Division ___________________________ Plaintiff(s) Case No. ________________ __________________________ Address ___________________________ City, State and Zip Code -vs____________________________ Defendant(s) ____________________________ Address ____________________________ City, State and Zip Code STIPULATION On the _________ day of ___________________, 20_____, the Plaintiff(s) did sue the Defendant(s) in the above styled cause. Defendant(s) admit the debt owing to Plaintiff(s), to wit: $____________, court cost in the amount of $_____________ have been incurred by Plaintiff(s). The total debt, including accrued court costs is $___________. Defendant(s) agree to pay the sum of $______________ to Plaintiff in the following manner: $____________ on ________________, and a like sum on the __________ day of each and every succeeding month thereafter until the sum of $____________ is paid to the Plaintiff. Upon failure of Defendant(s) to make any agreed payment when due, Plaintiff may file an affidavit so stating and Final Judgment will then issue for the balance owed Plaintiff by Defendant(s). ____________________________ Plaintiff ____________________________ Defendant ____________________________ Plaintiff ____________________________ Defendant Sworn to and subscribed before me this ______ day of _____________________, 20_____. _____________________________ Notary Public Form D American LegalNet, Inc. www.FormsWorkflow.com