IN THE COUNTY COURT IN AND FOR BROWARD COUNTY FLORIDA DIVISION [ ] CIVIL [ ] OTHER CLOCK IN STATEMENT OF CLAIM (AUTO NEGLIGENCE) PLAINTIFF (S) VS. DEFENDANT (S) CASE NUMBER ( )SP ( )CC COURT The plaintiff sues the defendant and says: On or about ______________________ , 20_____ , in the vicinity COUNTY OF ...................................................... : Index No. of _________________________________________________________________________________________________ : Calendar No. on a public highway in Broward County, Florida, plaintiff’s motor vehicle, being operated by __________________________ : JUDICIAL SUBPOENA Plaintiff(s) -against: _____________________________________; was in a collision with defendant’s motor vehicle being operated by _______ : _____________________________________________; and that said 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. Defendant(s) : ...................................................... Further, that the defendant is not in the Military Service of the United States. This action has been brought in a THE pursuant to Chapter 47, Florida county in which venue is proper,PEOPLE OF THE STATE OF NEW YORKStatutes. TO GREETINGS: WHEREFORE, plaintiff demands Judgment in the amount of $_________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before plus Court Costs. , the Honorable at the Court located at County of 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 witness in this action on the part of the SWORN TO AND SUBSCRIBED BEFORE ME this ________ day of ____________________ 20____ . Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable , one of the Justices of the NOTARY PUBLIC Court in County, day of State of Florida_____________________________________ My commission expires: , 20 Howard C. Forman, CLERK OF COURTS BY_____________________________________________ (Attorney must sign above and type name below) DEPUTY CLERK Attorney/Plaintiff Attorney’s Bar for Attorney(s) No. Address of Attorney/Plaintiff __________________________________________________ Office and P.O. Address __________________________________________________ Attorney/Plaintiff Telephone No. __________________________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: FORM 634 REVISED 1/03 ( SEARCH FEE : 698 ) American LegalNet, Inc. www.USCourtForms.com COPY FEE : 699