IN THE SUMMARY PROCEDURE DIVISION OF THE COUNTY COURT OKALOOSA COUNTY, FLORIDA ___________________________ ___________________________ Plaintiff(s) Vs ___________________________ ___________________________ Defendant(s) REQUEST FOR DISMISSAL The Plaintiff(s) herein states that the claim has been completely statisfied, and requests the Court to dismiss the above cause with prejudice. Case #: _________________ _____________________________________ Plaintiff _____________________________________ Plaintiff Sworn to and subscribed before me this _____ day of _________________, 20_____. ________________________________________________ Deputy Clerk of Notary Public American LegalNet, Inc. www.FormsWorkFlow.com