SC 003 (Revised 6/05)
COUNTY COURT, PINELLAS COUNTY, FLORIDA
SMALL CLAIMS DIVISION
UCN: Reference No.:
Address: Plaintiff(s)
vs. Party/Parties to be served: (complete if suing a business)
Address: Defendant(s) Address:
STATEMENT OF CLAIM IN REPLEVIN
Plaintiff(s) sue(s) the Defendant(s) and alleges:
1. This an action to recover possession of personal property in Pinellas County, Florida.
2. The description of the property is: __________________________________________________
The value of the property is $ ______________________________________________________
3. Plaintiff is the lawful owner of the property and can identify the property as belonging to the Plaintiff
in the following manner: __________________________________________________________
4. Plaintiff is entitled to the possession of the property because (indicate proof of ownership) _______
5. To plaintiff’s best knowledge, information and belief, the property located at:
6. The property is wrongfully detained by defendant. Defendant came into possession of the property
by ___________________________________________________________________________
To the plaintiff’s best knowledge, information and belief, defendant detains the property because:
7. The property has not been taken under an execution or attachment against plaintiff’s property.
8. (Check if applicable) If the property is not retrieved, Plaintiff seeks, in the alternative:
Damages sum of $
plus interest in the amount of $
WHEREFORE, Plaintiff(s) demand against Defendant(s) Judgment for Possession of the property
and any sums as follows:
Damages 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 statement of claim in
replevin, that the facts stated in it are true, and that Defendant(s) is/are not in the military service of the
United States.
Signature of Attorney for Plaintiff(s) Signature of all Plaintiff(s) or Company Representative
Address:
Print name of all Plaintiff(s) or Company Representative
Title (if applicable)
SPN No.
Telephone No. Telephone No.
