(CAPTION) STATEMENT OF CLAIM Plaintiff, ______________________, sues defendant, ______________________, and alleges: There is now due, owing, and unpaid from defendant to plaintiff $____________ with interest since .....(date)....., for the following goods sold and delivered by plaintiff to defendant between .....(date)....., and .....(date).....: (list goods and prices and any credits) WHEREFORE, plaintiff demands judgment for damages against defendant.
This is an official court form that provides a simple, fill-in-the-blank template for a lawsuit where a seller is suing a buyer for the price of goods that were sold and delivered but not paid for. The plaintiff fills in the names, dates, amount owed, and a list of the goods to create their official "Statement of Claim."