IN THE COUNTY COURT OF POLK COUNTY, FLORIDA CLAIMS DIVISION CASE NO. _________________________ ___________________________________________ ___________________________________________ ___________________________________________ Plaintiff(s), vs. ___________________________________________ ___________________________________________ ___________________________________________ Defendant(s). STATEMENT OF CLAIM IN REPLEVIN 1. 2. Plaintiff sues defendant and alleges: This is an action to recover possession of personal property in __________ County Florida. The description of the property is _________________________________________ ____________________________________________________________________ _____________________________________________________________________. To the best of plaintiff's knowledge, information and belief, the value of the property is $____________. Plaintiff is entitled to the possession of the property under a security agreement dated _______________, a copy of the agreement being attached, or because __________ ______________________________________________________________________. To plaintiff's best knowledge, information and belief, the property is located at ______________________________________________________________________ ____________________________________________________________________. The property is wrongfully detained by the defendant. Defendant came into possession of the property by ______________________________________________________ ____________________________________________________________________. The property has not been taken for a tax, assessment, or fine pursuant to law, nor has it been taken under an execution or attachment against the property of the plaintiff. 3. 4. 5. 6. WHEREFORE, plaintiff demands judgment for possession of said property and damages for the wrongful detention thereof, or, if said property is not in the possession of the defendant, the plaintiff demands judgment in the amount of $_______________ plus all costs of this action. Subscribed and sworn to before me this ______ day of__________, A.D. _____. ___________________________ Plaintiff ___________________________ Phone ___Personally Known ___Produced Identification Type of identification presented: _______________ STACY M. BUTTERFIELD, Clerk of the Circuit Court By_________________________D.C. or By__________________________, Notary Public Commission Expires: STACY M. BUTTERFIELD, Clerk of the Circuit Court American LegalNet, Inc. www.FormsWorkFlow.com