Form Clk/ct. 792 - Statement Of Claim (Promissory Note)
Download a blank fillable Form Clk/ct. 792 - Statement Of Claim (Promissory Note) in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Clk/ct. 792 - Statement Of Claim (Promissory Note) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2PLEASE USE TAB OR MOUSE
IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY, FLORIDA.
CASE NUMBER
DIVISION
STATEMENT OF CLAIM
CIVIL
(PROMISSORY NOTE)
DISTRICTS
(File in Duplicate Plus One For Each Defendant)
SECTION NO.
OTHER
PLAINTIFF
VS.
DEFENDANT(S)
CLOCK IN
The Plaintiff sues the Defendant for money
Address:
Phone Number:
owed Plaintiff by Defendant; and which is past
due and unpaid; for (As marked (x) below):
Plaintiff(s), _________________________________________________, sues defendant(s), _____________________________
____________________________________________________, and alleges:
1.
This is an action for damages that do not exceed the sum of $ _________________.
2.
On ___________________________, 20 ______, defendant executed and delivered to plaintiff a promissory note, a copy being attached, in
_________________ County, Florida.
3.
Defendant failed to pay
a) said note when due; or
b) the installment payment due on said note on _____________________, 20 _____, and plaintiff elected to accelerate
payment of the balance.
4.
There is now due, owing and unpaid from defendant(s) to Plaintiff(s) $_______________ on said note with interest since
___________________________, 20_____.
5.
Plaintiff(s) has obligated himself/herself to pay his/her attorney(s) a reasonable fee for their services in bringing this action.
Where Plaintiff demands judgment in the sum of $ ________________ together with court costs and any further costs which the Court may assess.
The Plaintiff, ________________________________________ says the foregoing is a just and true statement of the amount owed by defendant to
plaintiff, exclusive of all lawful setoffs, and that defendant has no lawful defenses which would preclude the collection of said amount.
Affiant states that the defendant(s) is/are not in the military service of the United States.
Attorney/Plaintiff
Signature
Attorney’s Bar No.
Address of Attorney/Plaintiff
Telephone No.
The foregoing instrument was acknowledged before me this ___________ day of ___________________________, 20____ by
____________________________ who is personally known to me or who has produced _____________________ as identification
and did
/ did not
take an oath.
SWORN TO AND SUBSCRIBED BEFORE ME this ______ day of __________________________ 20_____.
NOTARY PUBLIC,
HARVEY RUVIN
State of Florida _____________________
CLERK OF COURTS
_________________________________
Deputy Clerk
My Commission Expires:
IMPORTANT: SEE REVERSE
PRINT
SAVE
RESET
CLK/CT. 792 Rev. 06/11
Clerk’s web address:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal