IN THE COUNTY COURT OF POLK COUNTY, FLORIDA

CLAIMS DIVISION

CASE NO. _______________________

Plaintiff ,

vs.

Defendant .

__________________________________/

NOTICE OF DISMISSAL

    The plaintiff hereby files this Notice of Dismissal of Plaintiff's Statement of Claim pursuant to Rule 7.110(a)(1).

    Dated this _____ day of ___________________, 19_____.

CERTIFICATE OF SERVICE

    I HEREBY CERTIFY that a true and correct copy of the above has been furnished by regular U.S. Mail to ____________________________________________________ this _____ day of __________________, 19_____.

__________________________________

Plaintiff

c:\civil\forms\75.doc (7/96)