EXAMPLE IN THE COUNTY COURT IN AND FOR CITRUS COUNTY FIFTH JUDICIAL CIRCUIT OF FLORIDA CASE NO.__________________ YOUR NAME OR BUSINESS NAME MAILING ADDRESS CITY, STATE, ZIP TELEPHONE NUMBER Plaintiff(s) -vsPERSON OR BUSINESS NAME ADDRESS TO BE SERVED AND MAILING ADDRESS IF DIFFERENT CITY, STATE, ZIP TELEPHONE NUMBER Defendant(s) _________________________________/ STATEMENT OF CLAIM (REPLEVIN) The plaintiff(s) sues defendant(s) and alleges: This is an action to recover possession of personal property within the jurisdiction of this court the value of which does not exceed the amount of $5000.00 exclusive of costs, interest and attorney’s fees. The description of the property is: LIST OF CLAIMED PROPERTY SUFFICIENT TO MAKE IDENTIFICATION POSSIBLE DO NOT INCLUDE COURT COSTS IN THE VALUE OF THE PROPERTY LISTED That the true value of said property is the sum of $___________; that said property has not been taken for any tax, assessment or fine levied by virtue of any law of the State of Florida, nor seized under execution or attachment against the goods and chattels of said plaintiff(s) liable to execution and that the above named defendant(s) has/have possession of the above described personal property and detains the same from plaintiff(s). That said plaintiff(s) is the owner of said personal property and entitled to the possession thereof; that said defendant(s), wrongfully detains from said plaintiff(s) said personal property of the value as aforesaid; that said plaintiff(s) made demand upon said defendant(s) for possession of said personal property prior to the institution of this claim, yet said defendant(s) continues to wrongfully withhold possession thereof from said plaintiff(s). WHEREFORE, plaintiff(s) demands judgment for possession of the property against defendant. STATE OF FLORIDA, COUNTY OF CITRUS The undersigned being first duly sworn on oath, states the foregoing is a just and true statement. Affiant further states that the defendant(s) is/are not in the military service of the United States, and that the action has been brought in the county in which venue is proper, pursuant to Chapter 47, Florida Statutes. ______________________________________________________ AFFIANT Subscribed and sworn before me this _________ day of _________________________, 20____. BETTY STRIFLER CLERK OF THE COURT Betty Strifler, Clerk of the Circuit Court 110 N. Apopka Avenue, Room 101 Inverness, Fl. 34450-4299 (352) 341-6453 By:_____________________________________________ Deputy Clerk Or:________________________________________________ Notary Public C:/COUNTY/FORMS/SMALL CLAIMS/Small Claims Replevin Packet/6/2004 American LegalNet, Inc. www.FormsWorkflow.com IN THE COUNTY COURT OF THE FIFTH JUDICIAL CIRCUIT IN AND FOR CITRUS COUNTY, FLORIDA CASE NO.__________________ Plaintiff(s) -vs- Defendant(s) ________________________________/ STATEMENT OF CLAIM (REPLEVIN) The plaintiff(s) sues defendant(s) and alleges: This is an action to recover possession of personal property within the jurisdiction of this court, the value of which does not exceed the amount of $5,000.00 exclusive of costs, interest and attorney’s fees. The description of the property is: That the true value of said property is the sum of $___________; that said property has not been taken for any tax, assessment or fine levied by virtue of any law of the State of Florida, nor seized under execution or attachment against the goods and chattels of said plaintiff(s) liable to execution and that the above named defendant(s) has/have possession of the above described personal property and detains the same from plaintiff(s). That said plaintiff(s) is/are the owner(s) of said personal property and entitled to the possession thereof; that said defendant(s), wrongfully detains from said plaintiff(s) said personal property of the value as aforesaid; that said plaintiff(s) made demand upon said defendant(s) for possession of said personal property prior to the institution of this claim, yet said defendant(s) continues to wrongfully withhold possession thereof from said plaintiff(s). WHEREFORE, plaintiff(s) demands judgment for possession of the property against defendant. STATE OF FLORIDA, COUNTY OF CITRUS The undersigned being first duly sworn on oath, states the foregoing is a just and true statement. Affiant further states that the defendant(s) is/are not in the military service of the United States, and that the action has been brought in the county in which venue is proper, pursuant to Chapter 47, Florida Statutes. ______________________________________________________ AFFIANT Subscribed and sworn before me this _________ day of _________________________, 20____. BETTY STRIFLER CLERK OF THE COURT Betty Strifler, Clerk of the Circuit Court 110 N. Apopka Avenue, Room 101 Inverness, Fl. 34450-4299 (352) 341-6453 By:_____________________________________________ Deputy Clerk Or:________________________________________________ Notary Public C:/COUNTY/FORMS/SMALL CLAIMS/Small Claims Replevin Packet/6/2004 American LegalNet, Inc. www.FormsWorkflow.com