(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 $ ______.
Fl. Sm. Clm. R. form 7.330