IN THE COUNTY COURT OF POLK COUNTY, FLORIDA

CIVIL DIVISION

CASE NO. ______________________________

Plaintiff &

Counter-Defendant ,

vs.

Defendant &

Counter-Plaintiff .

_______________________________________________________/

Before me personally appeared the undersigned who being by me first duly sworn says: that he/she is the above named counter-plaintiff; that said counter-plaintiff is lawfully entitled to the possession of the following described property, situate in Polk County, Florida, to wit:

That the true value of said property is the sum of $_____________, that said property has not been taken for any tax, assessment or fine levied by virtue of any law of the State of Florida, nor seized under any execution or attachment against the goods and chattels of said counter-plaintiff liable to execution and that the above named counter-defendant has possession of the above described property and detains same from the counter-plaintiff.

That said counter-plaintiff is the owner of said property and entitled to the possession thereof; that said counter-defendant, in Polk County, Florida, wrongfully detains from said counter-plaintiff said property of the value as aforesaid; that said counter-plaintiff made demand upon said counter-defendant for possession of said property prior to the institution of this claim, yet said counter-defendant continues to withhold possession thereof from said counter-plaintiff.

Said counter-plaintiff demands judgment for possession of said property and damages for the wrongful detention thereof, or, if said property is not in the possession of the counter-defendant, the counter-plaintiff demands judgment for the value thereof, in the amount of $_____________ plus all costs of this suit.

_______________________________________

Defendant/Counter-Plaintiff

                                                                                                                            ______________________________________

                                                                                                                                                                         Phone Number

SWORN TO AND SUBSCRIBED BEFORE ME

this _____ day of ____________________, 19____.

Richard E. Weiss, Clerk
Circuit & County Courts                                 ____     Personally Known

                                                                  ____     Produced Identification

By___________________________                          Type of identification

            Deputy Clerk                                               presented: _______________________________________

I hereby certify that a copy of the above Counterclaim in Replevin has been sent by regular U.S. Mail to the Plaintiff/Counter-Defendant this _____ day of ____, 19____.

                                                                                                         _________________________________________________

                                                                                                         Deputy Clerk