IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CLAIMS DIVISION CASE NO. _______________________ Plaintiff, vs. Defendant and Crossclaim Plaintiff, and Crossclaim Defendant. ___________________________________________________/ CROSSCLAIM the defendant and files this COMES NOW ____________________________________________ Statement of Claim and alleges: Defendant/Crossclaim Plaintiff demands WHEREFORE, _______________________________ in the sum of $________________. Crossclaim judgment to against _______________________________________ Defendant/Crossclaim Plaintiff Subscribed and sworn to before me this _____ day of ________________________, 19_____ RICHARD M. WEISS, Clerk ____ Personally Known Circuit and County Courts ____ Produced Identification By____________________________________D.C. Type of identification presented:______________________________ CERTIFICATE OF SERVICE I hereby certify that a copy of the above Crossclaim has been furnished to _______________________________ by regular U. S. Mail this _____ day of ___________________, 19____. BY:________________________________D.C. REV. 08/97 125.DOC (08/97) 2000 © American LegalNet, Inc.