STATE OF SUPERIOR COURT
COUNTY OF ________________________

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Plaintiff, )
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v. ) C.A. No. _________
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Defendant. )

COMPLAINT

1. West Palm Beach Florida car accident injury Plaintiff , (" ") is a resident of (insert city/ town), County of (insert county), State of (insert state).

2. Defendant, (" ") is a resident of (insert city/ town), County of (insert county), State of (insert state).

3. The amount in controversy satisfies the jurisdictional requirements of this Court and venue is proper in this Court as this action arose within (insert
county and state or insert other applicable basis for venue).

COUNT I

4. incorporates by reference Paragraphs 1 through 3 above as if set forth again in full.

5. On or about (insert date) at approximately (insert time), was the
driver of a motor vehicle, described as a (insert automobile description).

6. At that time and place, negligently operated a motor vehicle described as (insert automobile description), which was owned and operated by him, causing the automobile to strike 's vehicle.

7. owed a duty to exercise reasonable care in the operation of his vehicle and breached his duty as he failed to operate his vehicle in a safe, reasonable and prudent manner.

8. As a direct and proximate result of 's breach of duty, sustained severe injuries and damages, including injury to the cervical and lumbar spine as well as other physical and emotional injuries, costs of medical treatment for those injuries, a loss of earning capacity, a loss of earnings, pain and suffering and other consequential damages.

WHEREFORE, demands judgment against in an amount which exceeds the jurisdictional requirements of this Court, plus interest and costs; and demands such other and further relief as this Court may deem just, proper and equitable.

WEST PALM BEACH FLORIDA CAR ACCIDENT INJURY PLAINTIFF ,_____________
By his Attornyes

WEST PALM BEACH FLORIDA CAR ACCIDENT INJURY PLAINTIFF , , DEMANDS A TRIAL BY JURY ON ALL ISSUES TRIABLE OF RIGHT BY A JURY IN THE WITHIN ACTION.

WEST PALM BEACH FLORIDA CAR ACCIDENT INJURY PLAINTIFF ,_____________
By his Attorneys

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