IN THE CIRCUIT /COUNTY COURT OF THE THIR TE ENTH JUDICIAL CI RCU IT OF THE STATE OF FLORI DA, IN AND FOR HILLSBOROUGH COUNTY CIVI L DIVISI ON CA SE NO. Plaintiff(s): DI VI S ION: Address: City: State: Zip Code: Area Code: Telephone Number: VS. Defendant(s) COMPL AINT (For Tenant Eviction and/or Past-Due Rent) Plaintiff(s)___________________________as an individual/ corporation/ general partner, (circle one) sues Defendant(s)______________________________________________, and alleges: COUNT I 1. This is an action to evict a tenant from real property in Hillsborough County, Florida. 2. Plaintiff(s) owns /is landlord for the following residential or commercial property. (circle one) (circle one) ________________________________________________________________________ Address (Circle One) Apartment House Mobile Home 3. Defendant(s) has possession of property under an oral/written agreement to pay (circle one) rent of $____________ payable weekly or monthly. (If written, a copy must be attached.) (circle one) COCV1102(Rev.01-04-2005) Page 1 of 2>>>> 24. Defendant(s) failed to pay rent due ______________________________, ________. 5. Plaintiff(s) served Defendant(s) with a written notice on ____________, _________, to pay the rent or vacate the property, but Defendant refused to do either. A copy of the written notice is attached hereto and made a part of the Complaint. 6. The Plaintiff(s) has/has not received any payment since the notice was delivered. (circle one) 7. ONL Y APP LI E S TO MOBI LE HOM E EVI CTI ONS The above-described property is or is not in a mobile home park of ten or more lots. (circle one) The agreement to pay rent concerns the mobile home & lot or the lot only. (circle one) WHE RE FORE , Plaintiff(s) demand judgment for possession of the property against Defendant(s), costs and attorneys fees (if Plaintiff is represented by counsel). COUNT II 8. This is an action for past due rent. 9. The Defendant(s) owe the Plaintiff(s) $________________ for past due rents as of the date of the filing of this Complaint. WHE RE FORE , Plaintiff(s) demand judgment for past due rent, including rents accruing since the filing of this action, costs and attorneys fees (if Plaintiff is represented by attorney). _______________________________________ PL AINTIFF S T AT E OF F L ORI DA C OU NT Y OF HIL L S BOR OU GH T he foregoing instrument was acknowledged before me this day of , , by ,who is personally known to me or who has produced as identification and who did [ ] did not [ ] take an oath. PA T FR A NK As Clerk of the Court As Deputy Cler k Notary Public Typed or Printed Name PA T FR A NK , Clerk of the Court M ailing Address: County Civil Office located at: County Civil Division 1st Floor P. O. Box 1110 George E. Edgecomb Courthouse T ampa, Florida 33601 800 E. Twiggs Street COCV1102(Rev. 01-04-2005) Page 2 of 2 T ampa FL 33602