IN THE COUNTY COURT OF SARASOTA COUNTY, FLORIDA DIVISION: CASE NUMBER: CIVIL PLAINTIFF VS. DEFENDANT ___________________________ Name ___________________________ Address ___________________________ City, State & Zip Code ___________________________ Phone: ___________________________ Name ___________________________ Address ___________________________ City, State & Zip Code ___________________________ Phone: VS. DEFENDANT ___________________________ Name ___________________________ Address ___________________________ City, State & Zip Code ___________________________ Phone: ___________________________ Name ___________________________ Address ___________________________ City, State & Zip Code ___________________________ Phone: ___________________________ Name ________________________________ Address ________________________________ City, State & Zip Code ________________________________ Phone: STATEMENT OF CLAIM The above named Plaintiff(s) sue the above named Defendant(s) and alleges: 1. This is an action for damages which do not exceed the amount of $5,000.00 exclusive of costs, interest and attorney fees. 2. The Plaintiff(s) claims the amount of $____________as being due from the Defendant(s) and alleges as the basis of such suit: Wherefore, Plaintiff(s) demands judgment for damages against Defendant(s) in the above amount plus all costs of this action. __________________________ Signature of Plaintiff or Attorney American LegalNet, Inc. www.FormsWorkflow.com