(CAPTION)
STATEMENT OF CLAIM
Plaintiff, ______________________, sues defendant, ______________________, and alleges:
1. This is an action for damages that do not exceed the jurisdictional amount pursuant to Florida Small Claims Rule 7.010(b).
2. On .....(date)....., 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 .....(date)....., and plaintiff (has/has not) elected to accelerate payment of the balance.
4. There is now due, owing, and unpaid from defendant to plaintiff $____________ on said note with interest since .....(date)......
WHEREFORE, plaintiff demands judgment for damages against defendant.
This is an official court form that provides a template for a lawsuit to collect money owed on a promissory note. A promissory note is a written promise to pay a specific amount of money by a certain date. The plaintiff fills in the details of the note and the amount owed to create their official "Statement of Claim." A copy of the promissory note must be attached.
