IN THE COUNTY COURT OF THE NINTH JUDICIAL CIRCUIT OF FLORIDA ORANGE COUNTY, FLORIDA CASE NUMBER __________________ Plaintiff(s) VS Defendant(s) STATEMENT OF CLAIM RENT-WRITTEN LEASE The above named Plaintiff(s) sue(s) the above named Defendant(s) for: That the plaintiff(s) and the defendant(s) made a written lease agreement, copy of which is annexed hereto as exhibit "A", and that pursuant to said lease agreement $_________ rent is owed to plaintiff(s) by defendant(s) and are now past due and unpaid. And Plaintiff(s) claim(s) $__________ damages not to exceed $5000.00 exclusive of interest, court costs and Attorney’s fees. ________________________________ Plaintiff(s) 2000 © American LegalNet, Inc.