Statement Of Claim - Florida
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IN THE COUNTY COURT IN AND FOR BROWARD COUNTY FLORIDA
DIVISION:
CIVIL
STATEMENT OF CLAIM
OTHER
PLAINTIFF (S)
vs.
DEFENDANT (S)
CASE NUMBER
SP
DIV:
The Plaintiff sues the Defendant for money owed Plaintiff by Defendant; and which is past due and unpaid;
for
(As marked (x) below) :
Goods, wares and merchandise sold by Plaintiff, to Defendant;
Work done and materials furnished by Plaintiff, to Defendant;
Money loaned by Plaintiff to Defendant;
Money due to Plaintiff upon accounts stated and agreed to between them;
On a written instrument, copy of which is attached hereto;
Rent for certain premises in Broward County, Florida, Viz;
Other (Explain)
Any additional facts in connection with any of the above:
(Use additional sheet if necessary)
Where Plaintiff demands judgment in the sum of $
together with court costs which the
court may assess. The Plaintiff, says the foregoing is a just and true statement of the amount owing by the
Defendant to Plaintiff, exclusive of all set-offs and just grounds of defense.
Affiant states that the Defendant(s) is/are not in the military service of the United States.
SWORN AND SUBSCRIBED BEFORE ME
this _______ day of _____________________ , 20______ .
HOWARD C. FORMAN,
PLAINTIFF OR ATTORNEY
CLERK OF COURTS
ADDRESS OF PLAINTIFF/ATTORNEY
by:____________________________________________
DEPUTY CLERK
NOTARY PUBLIC
PLAINTIFF/ATTORNEY TELEPHONE
State of Florida
MY COMMISSION EXPIRES:
(
)
ATTORNEY BAR NUMBER:
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