IN THE COUNTY COURT IN AND FOR DUVAL COUNTY, FLORIDA CASE NUMBER: DIVISION: Name:_________________________________ Address: _______________________________ Telephone:_____________________________, Plaintiff VS. Name:________________________________ Address:______________________________ Telephone:____________________________, Defendant Statement of Claim (Services Rendered upon Defendants Request) The Plaintiff(s) sue the Defendant(s) and alleges: 1. The is an action for damages which does not exceed the sum of $5,000, exclusive of interest and costs 2. Plaintiff is seeking to recover monies due from the Defendant for __________________________________ __________________________________________________________________________________________ services rendered at Defendant's request on or about _____________________________________________. 3. There is currently due, owing and unpaid the sum of $__________________ for said services as evidence per the attached. WHEREFORE Plaintiff demands judgment in the sum of $____________ plus court costs. ___________________________ (Print name) ___________________________ (Signature) American LegalNet, Inc. www.FormsWorkFlow.com