IN THE COUNTY COURT OF POLK COUNTY, FLORIDA

CIVIL DIVISION

CASE NO. _________________________

Plaintiff, 

vs.

Defendant.

_______________________________________________/

COMES NOW the plaintiff(s) and alleges that ____________________ is / are the owner(s) or

                                                                               (he/she/they)

lienholder(s) of ___________________________ that is being stored at defendant’s place of business.

Defendant claims that $_______________ is owed for towing and storage per the attached.

Plaintiff is depositing with the Clerk of the County Court of Polk County, Florida, the amount being claimed by the defendant and does hereby request the release of said vehicle.

Plaintiff further requests a hearing to determine if said vehicle was wrongfully taken or withheld from ________________.

                                                                                                                                                    him/her/them.

                                                                                                                                  ___________________________________
                                                                                                                                                                                     Plaintiff

                                                                                                                                  ___________________________________
                                                                                                                                                                                      Phone

Subscribed and sworn to before me                                            ____     Personally Known

this _____ day of ________________, 199___                             ____     Produced Identification

RICHARD M. WEISS, CLERK                                                              Type of identification

Circuit and County Courts                                                                    presented: _______________________

By____________________________________

            Deputy Clerk

Rev. 08/97

174.doc (08/97)