COURT

COUNTY OF
......................................................
: Index No.
IN THE COUNTY COURT IN AND FOR BROWARD COUNTY FLORIDA CLOCK IN
: Calendar No.
DIVISION :
[ ] CIVIL :
STATEMENT OF CLAIM
Plaintiff(s) JUDICIAL SUBPOENA
[ ] OTHER -against- :

PLAINTIFF(S) VS. DEFENDANT(S) :

:
Defendant(s) CASE NUMBER
:
......................................................

THE PEOPLE OF THE STATE OF NEW YORK [ ]SP

[ ]CC
TO

Plaintiff sues Defendant and alleges :

GREETINGS:

1. This is an WEaction
COMMAND for damages
YOU, thatthat do not exceed
all business and excuses $ 5000.00
being laidexclusive
aside, you of andinterest, costs,
each of you and
attend before
attorney’s
the Honorablefees. at the Court ,
2. County
This action
of is brought pursuant to the
located at Florida ( MOTOR VEHICLE REPAIR ACT FLORIDA)
STATUTE
in room 559.917 (1)(b) day of
, on the , 20 , at o'clock in the noon, and at any recessed
3. or
Onadjourned date, to testify and give evidence, as thea witness
Defendant in thisbrought
action onhis
themotor
part of vehicle,
the identified as
, into Plaintiff’s shop in Broward County, Florida
for the purpose of having the Plaintiff fix said automobile.
4. The Plaintiff, upon todiagnosing
Your failure comply withthe
thisproblem,
subpoena isissued
punishablea repair estimateofto
as a contempt theand
court Defendant, in the
will make you liable to
amount
the party onof whose
$ behalf this subpoena was issued ,which
for a estimate
maximum the Defendant
penalty of $50 and signed; a copy
all damages of
sustained as a
the repair
result of yourestimate is attached to the Statement of Claim and marked exhibit “A”.
failure to comply.
5. On , the Plaintiff notified the Defendant that the automobile
was completely fixed and that the defendant should come and pick
Witness, Honorable , one up said
of the automobile.
Justices of the
6. Court
On in County, day of , the Defendant , 20 came to the Plaintiff’s shop and was
presented with a written invoice, for the automobile repair, which showed that $
was owed. Said figure does not exceed the written estimate by $10.00 or 10% whichever is
greater. A copy of the written invoice is attached to this statement
(Attorney must sign of claim
above and
and type marked
name below) “
exhibit “B”.
7. The Defendant refused to pay for automobile repair.
Attorney(s) for

Office and P.O. Address

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 COURT
COUNTY OF
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: Index No.

: Calendar No.
8. The Defendant posted a Bond in the amount of $ , with the Clerk of the Court
:
of Broward County, Florida and received a certificate from the Clerk requiring
Plaintiff(s) JUDICIAL that possession of
SUBPOENA
the automobile be given to the
-against- Defendant. A copy of the
: Clerk’s certificate is attached and
marked as exhibit “C”.
:
9. The Plaintiff performed all of the work on the defendant’s automobile that was authorized:
Plaintiff demanded payment therefore but Defendant refused
: to pay.
Defendant(s) :
10. .From
. . . . . .the
. . . day
. . . . .that
. . . .the
. . . .Defendant
. . . . . . . . . . was
. . . . .notified
. . . . . . . that
. . . . .the
. . . work
. was completed on his car until the
day that the car was released $ of storage charges accrued.

THE PEOPLE OF THE STATE OF NEW YORK

WHEREFORE, Plaintiff demands that judgment be entered against the Defendant in the amount of
of $
TO plus $ storage charges, court costs and that the bond,
which the Defendant posted with the Clerk of Court, be released in favor of the Plaintiff.

GREETINGS:

WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable at the Court ,
County of located at
in room , on the day of , 20 , at o'clock in the noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the

Plaintiff
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Sworn to and subscribed before me this day of , 20 , at Broward County,
Florida. Witness, Honorable , one of the Justices of the
Court in County, day of , 20

(Attorney must sign above and type name below)

Deputy Clerkforor Notary Public

Attorney(s)

Office and P.O. Address

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