DEPARTMENT OF HIGHWAY SAFETY                                              FOLDER NUMBER ________________________________

AND MOTOR VEHICLES

BUREAU OF FINANCIAL RESPONSIBILITY                                        IN RE: SMALL CLAIMS COURT

NEIL KIRKMAN BUILDING                                                                              CASE NO. _______________________________

TALLAHASSEE, FLORIDA 32301

________________________________________________________ Plaintiff(s)

v.

________________________________________________________ Defendant(s)

YOU ARE HEREBY NOTIFIED THAT:

    _______________________________________________________________ was/were sued for damages and a judgment of $________________, plus $__________ costs, was rendered on __________________________ against the

                                                                                                    (date of Judgment)

following named Defendant(s) _________________________________________________________________________

                                                             (name of Defendant(s) against whom Judgment awarded)

in an action for damages to/on ________________________________________________________________________,

                                                             (property damages or on a promissory note)

resulting from the operation of a motor vehicle on _____________________________, in ___________________ County,

                                                                                   (date of accident)

Florida.

    As of the date of this letter, no notice of appeal of the aforesaid Judgment has been filed with the Clerk of this Court, nor has the said Judgment been stayed or satisfied according to the records of this Court.

    Since this Judgment has become final by expiration without appeal, any security that has been deposited by or on behalf of the Judgment debtor pursuant to Section 324.061, Florida Statutes, may be released in full or partial satisfaction of the said Judgment, or such other action taken as is authorized by law.

    Dated this _______ day of _______________________, 19_____, A. D.

________________________________________                                                  _______________________________________

Creditor's Name                                                                                                 Signature of Court Clerk or Judge

________________________________________                                                  _______________________________________

Address                                                                                                            Court

________________________________________                                                  _______________________________________

City                                                  State                                                          Address of Court

________________________________________

Attorney for Creditor

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