Miss. R. Civ. P. Form 14
As amended through October 31, 2024
1. On or about the ___________ day of _______________. 20________, defendant insured plaintiffs dwelling house (or other property, as the case may be) against loss or injury by fire and other perils in a policy of insurance, for the term of _____________ years.
2. The house (or other property) was wholly destroyed (or was damaged) by fire on the ___________ day of ____________________, 20_______, of which the defendant has had notice.
Wherefore plaintiff demands judgment against defendant in the sum of _______________ dollars, interest and costs.
Miss. R. Civ. P. Form 14