(CAPTION)
STATEMENT OF CLAIM
The plaintiff,______________________, sues the defendant, ______________________, and alleges: On or about ______________________, in the vicinity of ______________________, on a public highway in __________ County, Florida, plaintiff’s motor vehicle, being operated by ______________________, collided with defendant’s motor vehicle, being operated by ______________________; and the 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 $____________.
This is an official court form that provides a simple, fill-in-the-blank template for starting a lawsuit related to a car accident where only property damage is being claimed. The plaintiff fills in the names, date, location, and dollar amount of the damages to create their official "Statement of Claim," which is the document that begins the small claims case.
