INSTRUCTIONS FOR STATEMENT OF CLAIM A Statement of Claim is the form used to file a Small Claims case for monetary purposes only. You must have a complete name and address of the person(s) being sued. A brief explanation us required and any supporting documents are to be attached. A pre-trial date will be set and you will need to appear at that time along with the defendant for the judge to hear your case. If you are awarded a Judgment, the Judge will add all costs incurred in filing the case. These costs need not be included in your claim. This form is accompanied by a Plaintiff's Statement. Contact the Civil Law Department at (904) 284/269-6363 if you have any questions regarding completing this form. 2002 © American LegalNet, Inc. IN THE COUNTY COURT IN AND FOR CLAY COUNTY, FLORIDA Plaintiff CASE NO. -VS- Defendant STATEMENT OF CLAIM Plaintiff, , sues defendant , and alleges and says: THE AMOUNT OF THIS CLAIM IS $ WHEREFORE, Plaintiff demands judgment for damages against defendant DO NOT WRITE ON THE BACK OF THIS FORM. IF YOU NEED ADDITIONAL SPACE, PLEASE CONTINUE ON A SEPARATE SHEET OF PAPER. 2002 © American LegalNet, Inc.