IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CLAIMS DIVISION CASE NO. _______________________ Plaintiff , vs. Defendant . __________________________________/ NOTICE OF DISMISSAL The plaintiff hereby files this Notice of Dismissal of Plaintiff's Statement of Claim pursuant to Rule 7.110(a)(1). Dated this _____ day of ___________________, 20_____. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the above has been furnished by regular U.S. Mail to ____________________________________________________ this _____ day of __________________, 20_____. __________________________________ Plaintiff c:\civil\forms\75.doc (7/96) 2000 © American LegalNet, Inc.