COUNTY COURT, PINELLAS COUNTY, FLORIDA SMALL CLAIMS DIVISION UCN: Reference No.: Address: vs. Plaintiff(s) Address: Defendant(s)/Third Party Plaintiff(s) Address: Third Party Defendant(s) Party/Parties to be served: (complete if suing a business) Address: THIRD PARTY COMPLAINT Defendant(s)/Third Party Plaintiff(s) sue(s) the Third Party Defendant(s) for damages which do not exceed $5,000.00 exclusive of costs, interest and attorney's fee for (check one category below): Auto Accident Bad Check - Select one: insufficient funds stop payment other Breach of Agreement - Select one: oral agreement written agreement Select one: Goods or merchandise � Select one: sold by Plaintiff ) received by Plaintiff ) Money paid for either goods or services not provided Services including materials � Select one: rendered by Plaintiff received by Plaintiff Wages including salary, commission or fees Money loaned - Select one oral loan ) written loan Rent/Property Damage - Select one oral lease written lease Amount claimed for Rent: _______________ Amount claimed for Property Damage: ______________ Security Deposit claim Other claim � Please specify: _________________________________________________________________ Explain below the details (what happened, dates, times, place, etc) of your claim. This section must be completed. Attached is a copy of any written document(s) that is the basis of this claim. WHEREFORE, the Defendant(s)/Third Party Plaintiff(s) demand judgment in the principal sum of $ plus costs in the amount of $ plus interest in the amount of $ plus attorney's fee in the amount of $ Under penalties of perjury, I / We declare that I / We have read the foregoing third party complaint, that the facts stated in it are true, and that Third Party Defendant(s) is/are not in the military service of the United States. Signature of Attorney for Defendant(s)/Third Party Plaintiff(s) Address: Signature of all Defendant(s)/Third Party Plaintiff(s) or Company Representative Print name of all Defendant(s)/Third Party Plaintiff(s) or Company Representative Title (if applicable) SPN No. Telephone No. SC 075 (Revised 6/05) American LegalNet, Inc. www.FormsWorkflow.com Telephone No.