IN THE COUNTY COURT IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA ______________________ DIVISION , Plaintiff, -vs- , Defendant. ) ) ) ) ) ) ) ) ) ) ) ) Case No. Judge STATEMENT OF CLAIM (PROMISSORY NOTE) Plaintiff , , sues Defendant, , and allege(s): 1. This is an action for damages which (insert jurisdictional amount) . 2. On attached, in , Defendant executed and delivered to Plaintiff a promissory note, a copy being County, Florida. 3. Defendant failed to pay (a) said note when due; or the installment payment due on said note on (b) payment of the balance. 4. There is now due, owing, and unpaid from Defendant to Plaintiff $ since . , and Plaintiff elected to accelerate on said note with interest 5. Plaintiff has obligated himself/herself to pay his/her attorney(s) a reasonable fee for their services in bringing this action. Statement Of Claim Promissory Note {7.334} Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com WHEREFORE, Plaintiff demands judgment for damages against Defendant. Attorney or Plaintiff Firm/Address Phone/fax Florida Bar No. Statement Of Claim Promissory Note {7.334} Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com