In the County Court in and for Manatee County, Florida
______________________________________________ Plaintiff(s) Name ______________________________________________ Address ______________________________________________ City, State, Zip Code ______________________________________________ Telephone Number vs ______________________________________________ Defendant(s) Name ______________________________________________ Address ______________________________________________ City, State, Zip Code ______________________________________________ Telephone Number Case No.___________________________
Auto Negligence Statement of Claim
This claim does not exceed the amount of $5,000.00, exclusive of costs, interest and attorney's fees. The Plaintiff(s) sues the Defendant(s) and says: On or about the date of (month/day/year) __________________________ in the vicinity of __________________________________________________________ on a public highway in Manatee County, Florida, Plaintiff's motor vehicle, being operated by______________________________________ was in collision with defendant's motor vehicle being operated by _________________________________________________________ and that said collision with Plaintiff's vehicle was caused by the negligent and careless operation of Defendant's vehicle, whereby Plaintiff's vehicle was damaged and depreciated in value. WHEREFORE, Plaintiff demands judgment in the sum of $________________________ plus all costs of this action. __________________________________________ Plaintiff's Signature
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