IN THE COUNTY COURT OF POLK COUNTY, FLORIDA

CLAIMS DIVISION

CASE NO. ___________________________

Plaintiff and

Counterclaim Defendant,

vs.

Defendant and

Counterclaim Plaintiff.

___________________________/

COMES NOW the defendant and files this Counterclaim to plaintiff’s Statement of Claim and alleges:

WHEREFORE, Defendant/Counterclaim Plaintiff demands judgment against the Plaintiff/Counterclaim Defendant in the sum of $_________________. 

_______________________________________

Defendant/Counterclaim Plaintiff

Subscribed and sworn to before me this

_____ day of __________________, 19___                                          ____     Personally Known

RICHARD M. WEISS, Clerk                                                               ____     Produced Identification

Circuit and County Courts                                                                             Type of identification

By______________________________D.C.                                                   presented:__________________________________                                                             

    I hereby certify that a copy of the above Counterclaim has been furnished to _____________________________ by regular U. S. Mail this _____ day of ___________________, 19_____.

                                                                                                                        RICHARD M. WEISS, Clerk

                                                                                                                        By____________________________________

                                                                                                                                Deputy Clerk