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Statement Of Claim-Landlord Tenant-Unpaid Rent (Pinellas) Form. This is a Florida form and can be use in Pinellas Local County.
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Tags: Statement Of Claim-Landlord Tenant-Unpaid Rent (Pinellas), Florida Local County, Pinellas
COUNTY COURT, PINELLAS COUNTY, FLORIDA
SMALL CLAIMS DIVISION
UCN: ______________________________ Reference No.: ______________________________
________________________________________________________
Address:
Plaintiff(s)
vs.
________________________________________________________
Address:
Defendant(s)
STATEMENT OF CLAIM - LANDLORD/TENANT - UNPAID RENT
Plaintiff(s) sue(s) the Defendant(s) for damages which do not exceed $5,000.00, exclusive of costs, interest and
attorney's fee (if appropriate) and alleges(s):
1.
On or about ____________________ , ________ , Plaintiff(s), Landlord(s), leased to Defendant(s), Tenant(s), premises
located at __________________________________________________________________ , Pinellas County , Florida.
2.
The lease was an oral lease containing the following provisions:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
(length of lease in months or years; amount of rent payment; notice requirement for vacating the premises; amount of security
deposit; and amount of prepaid last month's rent, if any)
— OR —
______________________________________________________________________________
(“A copy of the written lease is attached")
3.
Defendant(s) vacated the premises on or about _______________________________________________ , _______ .
4.
Defendant(s) failed to pay rent for the periods of _______________________________________________________ ,
leaving rent due and owing of $ ______________________
WHEREFORE, Plaintiff(s) demand judgment in the principal sum of $ __________ plus costs, interest and attorney's fee.
STATE OF FLORIDA
:
COUNTY OF PINELLAS : ss.
Plaintiff _________________________________________________________________________________________
(Please print Plaintiff’s/Plaintiffs’ name exactly as it appears at top of form.) states/state that the foregoing is a just and true statement
of the amount owed by Defendant(s) to Plaintiff(s) exclusive of all set-offs and just grounds of defense. Affiant states that Defendant(s) is/are
not in the military service of the United States.
_______________________________________________________________
Signature of Attorney for Plaintiff(s)
_____________________________________________________________
Signature of Plaintiff(s) or Agent
Address: ____________________________________
____________________________________
_____________________________________________________________
Title
Telephone No. _______________________________
Sworn to and subscribed before me this
_______________________________________________________________
Telephone No. ______________________________________________
SPN No. ________________________________________
________ day of ________________________ , __________ .
_____________________________________________________
Landlord/Tenant - Unpaid Rent
SC 044 (Rev. 1/1/03)
Deputy Clerk or Notary Public
State of Florida
My Commission expires:
SC 044
12/02
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