IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CLAIMS DIVISION CASE NO. ___________________________ Plaintiff and Counterclaim Defendant, vs. Defendant and Counterclaim Plaintiff. ______________________________________________/ COUNTERCLAIM COMES NOW the defendant and files this Counterclaim to plaintiff’s Statement of Claim and alleges: WHEREFORE, Defendant/Counterclaim Plaintiff demands judgment against the Plaintiff/Counterclaim Defendant in the sum of $_________________. _______________________________________ Defendant/Counterclaim Plaintiff Subscribed and sworn to before me this _____ dayof __________________, ______ Personally Known RICHARD M. WEISS, Clerk of the Circuit Court Produced Identification Type of identification presented:___________________________________________ By______________________________, Deputy Clerk CERTIFICATE OF SERVICE I hereby certify that a copy of the above Counterclaim has been furnished to _______________________________ _________________________________________________________________________________________________ _ by regular U. S. Mail this _____ day of ___________________, _______. RICHARD M. WEISS, Clerk of the Circuit Court By____________________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com