(Form 80) IN THE COUNTY COURT, IN AND FOR DUVAL COUNTY, FLORIDA CASE NO: DIVISION: (Insert name of Landlord) vs. (Insert name of Tenant) Plaintiff(s) Defendant(s) AFFIDAVIT OF DAMAGES (Count II) STATE OF FLORIDA } COUNTY OF DUVAL } BEFORE ME, the undersigned authority, personally appeared who being first duly sworn, says: [name] , the Plaintiff or the Plaintiff 's agent (check appropriate response) in this case and 1. I am am authorized to make this affidavit. 2. This affidavit is based on my own personal knowledge. 3. Defendant has possession of the property which is the subject of this eviction under an per agreement to pay rent of $ [week, month, or other payment period] [rental amount] 4. Defendant has not paid the rent due since 5. Defendant owes Plaintiff $ interest. [date of payment tenant has failed to make] as alleged in the complaint plus . [past due rent amount] American LegalNet, Inc. www.FormsWorkFlow.com 6. Defendant owes Plaintiff $ interest. [amount of other damages] as alleged in the complaint plus Signature: Print Name: Acknowledged before me on produced known to me / did not take an oath. did / ,by , who as identification, and who is personally NOTARY PUBLIC-STATE OF FLORIDA Name: Commission No.: My Commission Expires: I CERTIFY that I mailed, affidavit to the Defendant at telefaxed and mailed, or hand delivered a copy of this [insert address at which tenant was served and telefax number if sent by telefax] Approved for use under rule 10-2.1(a) of the Rules Regulating The Florida Bar American LegalNet, Inc. www.FormsWorkFlow.com