SC 075 (Revised 01/2020)
COUNTY COURT, PINELLAS COUNTY, FLORIDA
SMALL CLAIMS DIVISION
UCN: Reference No.:
Address: Plaintiff(s)
vs.
Address: Defendant(s)/Third Party Plaintiff(s) Address: Third Party Defendant(s)
Party/Parties to be served: (complete if suing a business)
Address:
THIRD PARTY COMPLAINT
Defendant(s)/Third Party Plaintiff(s) sue(s) the Third Party Defendant(s) for damages which do not exceed
$8,000.00 exclusive of costs, interest and attorney’s fee for
(check one category below):
( ) Auto Accident
( ) Bad Check - Select one:
( ) insufficient funds ( ) stop payment ( ) other
( ) Breach of Agreement
- Select one: ( ) oral agreement ( ) written agreement
Select one:
( ) Goods or merchandise – Select one: ( ) sold by Plaintiff ( ) received by Plaintiff
( ) Money paid for either goods or services not provided
( ) Services including materials – Select one: ( ) rende
red by Plaintiff
( ) received by Plaintiff
( ) Wages including salary, commission or fees
( ) Mone
y loaned - Select one ( ) oral loan ( ) written loan
( ) Rent/Property Damage -
Select one ( ) oral lease ( ) written lease
Amount claimed for Rent: _______________ Amount claimed for Property Damage: ______________
( ) Securit
y Deposit
claim
( ) Other claim – Please spe
cify: _________________________________________________________________
Explain below the details (what happened, dates, times, place, etc) of your claim. This section must be completed.
( ) Attached is a copy of any written document(s) that is the basis of this claim.
WHEREFORE, the Defendant(s)/Third Party Plaintiff(s) demand judgment in the
principal sum of $
plus costs in the amount of $
plus interest in the amount of $
plus attorney’s fee in the amount of $
Under penalties of perjury, I / We declare that I / We have read the foregoing third party complaint, that the facts
stated in it are true, and that Third Party Defendant(s) is/are not in the military service of the United States.
Signature of Attorney for Defendant(s)/Third
Party Plaintiff(s)
Signature of
all Defendant(s)/Third Party Plaintiff(s) or
Company Representative
Address:
Print name of all Defendant(s)/Third Party Plaintiff(s) or
Company Repres
entative
Title (if applicable)
SPN No.
Telephone No. Telephone No.
