IN THE COUNTY COURT IN AND FOR LEON COUNTY, FLORIDA CASE NO. ____________________ ___________________________________________ PLAINTIFF ___________________________________________ ADDRESS ___________________________________________ CITY, STATE, ZIP CODE VS ___________________________________________ DEFENDANT ___________________________________________ ADDRESS ___________________________________________ CITY, STATE, ZIP CODE TELEPHONE:______________________________ TELEPHONE:______________________________ STATEMENT OF CLAIM Plaintiff(s), _____________________________________________________, sues Defendant(s), and alleges: 1. 2. This is an action for damages which does not exceed $5,000.00. Plaintiff(s) claims the amount of $______________ with interest from ___________________, as being due from said Defendant(s), and alleges as the basis of such suit: WHEREFORE, Plaintiff demands judgment in the amount of $______________________, plus all costs of this action. ____________________________________________ Plaintiff or Agent Revised 8/1/08 American LegalNet, Inc. www.FormsWorkFlow.com