IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA. DIVISION CIVIL DISTRICTS OTHER PLAINTIFF STATEMENT OF CLAIM FOR RETURN OF STOLEN PROPERTY (File in Duplicate Plus One For Each Defendant) CASE NUMBER SECTION NO. VS. DEFENDANT(S) PHONE NUMBER CLOCK IN Address Plaintiff, ______________________________ sues defendant, __________________________________ and says: This is an action for the return of stolen or misappropriated property pursuant to section 539.001, Florida Statutes. Plaintiff is the owner of the following described property: (USE ADDITIONAL SHEET IF NECESARRY) _______________________________________________________________________________________________ ________________________________________________________________________________________________ The above-described property was stolen or otherwise misappropriated from plaintiff on or about the ______ day of _______________________ 20____. A copy of the law enforcement report outlining the theft/misappropriation is attached hereto and incorporated into this statement of claim. The above-described property is currently in the possession of defendant and is located at a pawnshop as defined in section 539.001, Florida Statutes, the address of which is ___________________________________________________________ Plaintiff has complied with the procedural requirements of section 539.001, Florida Statutes. Specifically, plaintiff notified the pawnbroker of plaintiff's claim to the property: by certified mail, returned receipt requested, or in person evidenced by a signed receipt. The notice contains a complete and accurate description of the purchased or pledged goods and was accompanied by a legible copy of the aforementioned police report regarding the theft or misappropriation of the property. No resolution between plaintiff and defendant pawnbroker could be reached within 10 days after the delivery of the notice. Wherefore, the plaintiff demands judgment for the return of the property. Plaintiff further asks this court to award plaintiff the cost of this action, including reasonable attorneys' fees. Attorney/Plaintiff Address of Attorney/Plaintiff Signature Attorney's Bar No. Telephone No. The foregoing instrument was acknowledge before me this ______ day of _______________________, 20____ by ________________ who is personally known to me or who has produced _______________________ as identification and did /did not take an oath. SWORN TO AND SUBSCRIBED BEFORE ME this _______ day of __________________________ 20______. HARVEY RUVIN CLERK OF COURTS CLK/CT 931 Rev. 12/11 _________________________________ Deputy Clerk IMPORTANT: SEE REVERSE NOTARY PUBLIC, State of Florida ______________________ My Commission Expires: American LegalNet, Inc. www.FormsWorkFlow.com Clerk's web address: www.miami-dadeclerk.com SERVICE OF PROCESS PROCESS SHERIFF MAIL FILING FEE AMOUNT RECEIPT NUMBER NOTE: If the claim is based upon a written document, a copy, or the material part thereof, shall be attached to the statement of claim. INSTRUCTION SHEET IMPORTANT YOU MUST advise the Clerk, in writing, of any change in your mailing address. If you are a DEFENDANT and fail to appear on the designated date, in person or by an attorney, a judgment may be entered against you. Plaintiff(s) will not be entitled to a default or judgment in the absence of an affidavit regarding the defendant's military status in compliance with applicable law. This form, if sworn to will meet the above requirements. If you are a PLAINTIFF and fail to appear on the designated date, in person or by an attorney, this case may be dismissed for Want of Prosecution. Any claim of the Defendant against the Plaintiff, arising out of the same transaction or occurrence which is the subject matter of plaintiff's claim, shall be filed not less than 5 days prior to the appearance date or within such time as the Court designates. When a counterclaim or set-off exceeds the jurisdiction of the Court, it shall be filed in writing before or at the pre-trial hearing, and the action shall then be transferred to the Court having jurisdiction thereof. As evidence of good faith, the counter-claimant shall deposit a sum sufficient to pay the filing fee in the Court to which the case is to be transferred with his counterclaim. FAILURE TO MAKE THE DEPOSIT WAIVES THE RIGHT TO TRANSFER. TRIAL BY JURY may be upon written demands by Plaintiff made at the commencement of the action or by any defendant within 5 days after service of the notice to appear or at the Pretrial Conference. If the demand is not made, the right to trial by jury waived. If at any time the proceedings a settlement is reached between the parties, this office should be notified in writing by the Plaintiff. If you have any questions regarding procedures, this office will assist you. This office cannot furnish legal advice to you. Please consult your attorney for legal advice. CAUTION A copy of any paper that you file at any time with the Clerk or Judge MUST be sent by you to each attorney appearing in the case, if any, or to all parties not represented by an attorney. You must set forth the date and to whom you sent the copy (or copies) of the paper filed, which would be followed by your signature. AMERICANS WITH DISABILITIES ACT OF 1990 ADA NOTICE "If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact the Eleventh Judicial Circuit Court's ADA Coordinator, Lawson E. Thomas Courthouse Center, 175 NW 1st Ave., Suite 2702, Miami, FL 33128, Telephone (305) 349-7175; TDD (305) 349-7174, Fax (305) 349-7355 at least 7 days before your scheduled court appearance, or immediately upon receiving this notification if the time before the scheduled appearance is less than 7 days; if you are hearing or voice impaired, call 711." CLK/CT 931 Rev. 12/11 IMPORTANT: SEE REVERSE Clerk's web address: www.miami-dadeclerk.com American LegalNet, Inc. www.FormsWorkFlow.com