IN THE COUNTY COURT IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA ______________________ DIVISION ) ) ) ) ) ) ) ) ) ) ) ) , Plaintiff, -vs- Case No. Judge , Defendant(s). COMPLAINT* Plaintiff , Defendant(s), 1. This is an action for damages which (insert jurisdictional amount) . 2. On or about Defendant vehicles at Florida.. , Defendant in or , or both Defendants, owned and operated motor , , sues , and alleges: 3. At that time and place, Defendant(s), or one of them, negligently operated or maintained his/her/their motor vehicle(s) so that one or both of them collided with Plaintiff's motor vehicle. 4. As a result, Plaintiff suffered bodily injury and resulting pain and suffering, disability, disfigurement, mental anguish, loss of capacity for the enjoyment of life, expense of hospitalization, medical and nursing care and treatment, loss of earnings, loss of ability to earn money, and aggravation of a previously existing condition. The losses are either permanent or continuing and plaintiff will suffer the losses in the future. Plaintiff's automobile was damaged and (s)he lost the use of it during the period required for its repair or replacement. 5. (Other) *This form omits allegations for when owner and driver of either of Defendant vehicles are different persons. Motor Vehicle Negligence Complaint (Plaintiff Unable to Determine Who Is Responsible) {1.946} Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com WHEREFORE, Plaintiff demands judgment for damages against Defendants. Attorney or Plaintiff Firm/Address Phone/fax Florida Bar No. Motor Vehicle Negligence Complaint (Plaintiff Unable to Determine Who Is Responsible) {1.946} Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com