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Ken BurKe, C.P.A.
ClerK of the CirCuit Court And ComPtroller
PinellAs County, floridA
www.mypinellasclerk.org
COMPLAINT FOR EVICTION
(POSSESSION ONLY)
****** Important Information ******
Notice: Information or forms provided by the Clerk of the Circuit Court should be considered as basic
information only and may not be applicable to every situation. The information is not intended to be used
as legal advice. Specific guidance concerning filing a lawsuit, answering a lawsuit or questions about
your particular situation should be directed to a qualified attorney.
A tenant eviction is the legal procedure a landlord must follow to have a tenant removed from
the landlord’s property.
FILING FEE: $185.00
SUMMONS ISSUANCE FEE: $10.00 PER SUMMONS
Payable by cash / personal check / cashiers check / certified check / money order / traveler’s
check / credit card – in office payment only (American Express, Discover, MasterCard or Visa)
IN ADDITION TO THE ABOVE MENTIONED FILING FEE AND SUMMONS
ISSUANCE FEE, You must contact a private process server, or persons allowed to do service in
the county where service is to be done, to obtain their service fees. You can get a list of local
process servers from the Sheriff by accessing a link through the Clerk’s website at
www.mypinellasclerk.org. (Look for Process Servers under Find a Service.)
If service is outside of Pinellas County, you must contact the Sheriff of that county to
obtain applicable service fees prior to submitting payment for service. You will need to
provide our office with a pre-addressed stamped envelope for that county along with the
applicable fees. Make your check or money order payable to the Sheriff of the county
where service will be made.
YOU CAN BRING YOUR COMPLETED FORMS TO ANY ONE OF THE
FOLLOWING OFFICES OR
MAIL TO CIVIL COURT RECORDS:
Civil Court Records North County Branch Office St. Petersburg Branch Office
315 Court Street Room 170 29582 US Highway 19 North 545 1
st
Avenue North
Clearwater, FL 33756 Clearwater, FL 33761 St. Petersburg, FL 33701
If you have any questions, you may contact us at 727-464-7000.
If you feel you need further assistance or require any legal assistance regarding the completion
and/or filing of these forms, you may want to contact an attorney or visit the Self Help Center.
YOU MUST PROVIDE
self-addressed stamped envelopes and/or copies for each party for any
issue requiring the Judge’s signature or your issue WILL NOT be reviewed by the court.
5/2015 (Page 1 of 2) Residential Eviction for Non-Payment of Rent
SELF HELP CENTER
The Self Help Centers are the result of a collaborative effort between the Clerk’s Office, the Sixth Judicial Circuit,
the Community Law Program and the Clearwater Bar Association.
The purpose of the Clerk's Legal Self Help Centers is to assist citizens representing
themselves in court (sometimes referred to as pro se persons) who do NOT have a private attorney.
Citizens who represent themselves in court and do not already have a private attorney representing them, can
now get affordable legal assistance.
OUR SERVICES INCLUDE:
• Schedule an appointment to consult with an attorney for a minimum of $15.00*
(Attorneys may assist with Family Law, Small Claims and Landlord/Tenant matters ONLY.)
• Purchase forms and packets for the civil court actions listes above
• Have documents notarized
• Make copies
Open Monday through Friday from 8:30 a.m. until 4:30 p.m.:
•
The Clearwater Self Help Center
The New Courthouse
315 Court Street, Room 114
Clearwater, FL 33756
Phone: (727) 464-5150
Fax: (727) 453-3423
o Appointments may be scheduled for Wednesday,
Thursday and/or Friday.
o A Spanish interpreter provided by the
Hispanic Outreach Center is available by
appointment at the Clearwater location
•
The St. Petersburg Self Help
Center
The St. Petersburg Judicial Building
545 First Avenue North, Room 103
St Petersburg, FL 33701
Phone: (727) 582-7941
Fax: (727) 582-7945
o Appointments may be scheduled for
Monday, Wednesday, and/or Friday.
• The North County Branch Self Help Center
29582 U.S. 19 North
Clearwater, FL 33761
Phone: (727) 464-5150
Fax: (727) 453-3423
o Attorney appointments may be scheduled
for Tuesday only at this office.
Self Help Center Now Offering Online Scheduling of attorney consultation appointments for pro se litigants
that do not already have an attorney. To schedule an appointment online using a credit card, please visit
www.mypinellasclerk.org
and click on the SELF HELP CENTER link in the top menu.
*Attorney appointments may only be scheduled for a minimum of 15 minutes to a maximum of one hour. All appointments must be
scheduled in 15-minute increments, i.e., 15, 30, 45 or 60 minutes at a rate of $1 (one dollar) per minute, therefore payments will be $15, $30,
$45 or $60 accordingly.
Attorney consultation fees must be paid when the appointment time is scheduled. Payments must be by credit card,cash check or money
order. Refunds will not be issued for missed appointments.
Ken Burke, CPA
Clerk of the Circuit Court
& Comptroller
Pinellas County, Florida
9/2015 (Page 2 of 2) Residential Eviction for Non-Payment of Rent
WHEN SHOULD THIS PACKET BE USED?
This packet is for residential tenant eviction for non-payment of rent to obtain possession
of the property only.
The tenant did not pay the rent based on an oral or written lease agreement on a
residential property only.
Example – I am the owner and/or landlord and I have a rental agreement with a tenant.
The tenant is not paying the rent. I want them evicted.
BEFORE A LAWSUIT IS FILED, you must deliver the Notice from Landlord to Tenant –
Termination for Failure to Pay Rent [Form #1].
REVIEW the Filing Checklist / Quick Reference Guide prior to completing any forms.
REFER to chapters 45 through 57 and chapter 83 of the Florida Statutes for information
regarding filing a tenant eviction case.
Copies of these statutes are available at the law library located at the Clearwater
Courthouse, at your public library or online through the Florida Legislature website at
http://www.leg.state.fl.us/Statutes
DO NOT SIGN any documents that require a notary or deputy clerk signature until you are in
front of the notary or deputy clerk.
RETAIN COPIES of all forms filed for your records.
DOCUMENTS MUST BE LEGIBLE, type written or legibly handwritten in black or blue ink.
IT IS IMPORTANT that the names and addresses are the same on all documents.
A DELAY CAN OCCUR as a result of any errors on your paperwork or if the proper fees are
not submitted.
DO NOT ACCEPT ANY RENT after initiating the eviction process or your case may be
dismissed per Florida Statute 83.56(5).
Landlord posts or delivers
Notice to Tenant
Wait 3 days
for failure to pay rent / 7
days
for breaking other parts of lease*
Landlord files
Complaint
**
with
Civil
Cover Sheet
/
Summons
with Clerk -
Clerk issues summons
Defendant Served
Personal Service
If summons posted, mailing
packet required
Wait 5 days from date of service or if posted, from
date of posting or mailing, w hichever is later.
No Answer from Tenant
and
no monies deposited
Answer from Tenant
w / rent monies dep
or
No Answer
w / rent monies deposited
Landlord files
Motion for Clerk's
Default & Non-Military Affidavit
(Count 1)
Landlord calls judge to obtain hearing date and sends
Hearing Notices
to parties
Clerk enters Default
Hearing held
Landlord loses suit
Landlord wins suit and prepares F/J
for judge
Landlord files
Motion for Final Judgment
and prepares Final Judgment/Order for
Count 1
Court enters
Final
Judgment Count 1
Tenant still in Property
Money owed to Landlord
Landlord files Default on Count 2
Clerk sends Writ to
Sheriff and Final
Judgment to Recording
Sheriff removes
Tenant from property
Landlord files
Writ of Possession
and $90.00
check to Sheriff
Clerk enters
Default
Landlord files
Motion for
Final Judgment Ct I
I
Court enters
Final JDG Ct 2
Clerk forwards to Recording
Record Judgment as lien
Writ of Execution
Mtn for Wrt of
Garnishment
Count 1 Possession
Count 2 Damages/Money
*excludes Sat. Sun
and legal holidays
observed by the clerk
DELINQUENT TENANT ACTIONS
Answ er from Tenant w /
no
rent monies deposited
Landlord files
Motion for
Immediate (Court) Default
&
Non-Military Affid
.
Judge signs
OR
Revised 1/2/2013
Indicates what may happen
Indicates what will happen
Underlined words in Flow Chart indicate forms available on Clerk Internet (www.mypinellasclerk.org)
**Attach to Complaint filed with Clerk:
1) Copy of Lease (if any)
2) Copy of Notice
FILING CHECKLIST
RESIDENTIAL EVICTION FOR NON-PAYMENT OF RENT
(POSSESSION ONLY)
Step One
File Case with Clerk
To file an Eviction case, you may file the following forms along with the filing fee and any
service fees, if applicable, with the Clerk’s office.
Complaint for Eviction [Form #5] with attached copy of the written lease agreement
and/or Notice to Pay Rent [Form #1], if any
(1) Original filed with the Clerk and (1) copy for each Defendant(s) to be served*
Civil Cover Sheet [Form #1.997]
Authorization of Property Manager [Form #COCIV 87]
Only provide if you are a property manager filing a complaint on behalf of a landlord
Summons on Claim for Possession of Residential Premises [Form #7]
Must include Spanish and French translations (pg. 2 of Form #7)
(1) Original and (1) copy for each Defendant(s) to be served.*
* If you anticipate posting, per Florida Statute 48.183, the landlord must provide an additional copy of
the complaint, summons and a pre-addressed stamped envelope for mailing to each Defendant.
Step Two
Obtain Judgment
5 days (excluding weekends & legal holidays) after service on the Defendant(s) and the
Defendant(s):
DID NOT respond OR deposit money into the registry of the court, you may file the
following forms:
Nonmilitary Affidavit [Form #81]
Must be submitted per Local Rule 5(D) in order to obtain a Clerk’s Default
Motion for Clerk’s Default – Residential Eviction [Form #76]
Motion for Default Final Judgment – Residential Eviction [Form #78]
Final Judgment – Residential Eviction [Form #66]
(1) Original and (1) copy for each
Plaintiff and Defendant along with a pre-
addressed stamped envelope for each party
OR
DID respond, but DID NOT deposit any money into the registry of the court, you may
file the following forms:
Nonmilitary Affidavit [Form #81]
Must be submitted per Local Rule 5(D) in order to obtain a Clerk’s Default
Motion for Court’s Default – Residential Eviction [Form #COCIV 78]
Motion for Default Final Judgment – Residential Eviction [Form #78]
Final Judgment – Residential Eviction [Form #66]
(1) Original and (1) copy for each Plaintiff and Defendant along with a pre-
addressed stamped envelope for each party
3/2011 (Page 1 of 2) Residential Eviction for Non-Payment of Rent
3/2011 (Page 2 of 2) Residential Eviction for Non-Payment of Rent
OR
DID respond AND deposited money into the registry of the court OR DID respond
AND filed a Motion to Determine Amount of Rent, you may file the following forms:
Nonmilitary Affidavit [Form #81]
Motion/Order to Set Cause for Non-Jury Trial – Final Judgment [Form #New Form 10]
(1) Original and (1) copy for each Plaintiff and Defendant along with a pre-
addressed stamped envelope for each party
Final Judgment – Residential Eviction [Form #66]
Bring the Final Judgment and (1) copy for each Plaintiff and Defendant to the
hearing and (1) pre-addressed stamped envelope for each party
If the Judge grants your complaint, a Final Judgment will be signed.
Step Three
Obtain Writ of Possession
If the Defendant(s) refuse to leave the property after the Final Judgment has been signed,
you may file a Writ of Possession and have it issued by the Clerk, allowing the Sheriff’s
Department to remove them from the property.
Writ of Possession [Form #11]
Submit along with a check or money order for $90.00 payable to the Pinellas County
Sheriff’s Office (no out of state checks)
Additional Forms
Motion and Order to Disburse Funds from Registry of the Court [Form #New Form 13]
If any funds were deposited into the Registry of the Court and you would like to have it disbursed
to you, you may file this form.
Disclosure from Nonlawyer, if applicable [Form #14]
This form is for your records and should only be used if a nonlawyer assists you in completing
any forms. The nonlawyer must complete this form and both of you are to sign it before the
nonlawyer assists you with any forms.
Notice of Voluntary Dismissal [Form #New Form 15]
This form is to be completed and filed with the Clerk when you decide not to proceed with your
case prior to a judgment being entered. For example, use this form if the tenant moves out and it
is no longer necessary to obtain an Eviction Judgment.
Notice from Landlord of Intent to Impose Claim on Security Deposit [Form #12]
Pursuant to F.S. 83.49(3)(a), you must return a tenant’s security deposit to the tenant no more
than 15 days after the tenant leaves the leased property. You may claim all or a portion of the
security deposit only after giving the tenant written notice by certified mail to the tenant’s last
known mailing address of your intention to keep the deposit and the reason for keeping it. If the
tenant does not object to the notice, you may then keep the amount stated in the notice and must
send the rest of the deposit to the tenant within 30 days after the date of the notice.
QUICK REFERENCE GUIDE TO
COMPLETING FORMS PRIOR TO FILING
COMPLAINT FOR EVICTION (POSSESSTION ONLY)
Notice from Landlord to Tenant Termination for Failure to Pay Rent [Form #1] -
Print the name, address and telephone number of the tenant(s).
Read each line and select and/or fill in the appropriate response.
Date and sign in the space provided and print your name, address and telephone number.
After three days from the delivery of this notice, excluding the date of delivery,
Saturday, Sunday, and legal holidays, you may file a Tenant Eviction Case with the
Clerk of Court.
Instructions for form**:
This notice may be delivered by mail or by delivering a copy to the dwelling unit, or, if the Tenant is absent
from the dwelling unit, by leaving a copy thereof at the dwelling unit.
If the Tenant fails to pay rent when due and the default continues for three (3) days (excluding Saturday,
Sunday, and legal holidays) after delivery of written demand by the Landlord for payment of the rent or
possession of the premises, the Landlord may terminate the rental agreement. This written demand is a
prerequisite to an action to evict the Tenant or recover past due rent. Your written rental agreement may have
allowed for a longer period than
three days and should be reviewed.
SOURCE: Section 83.56(3) and (4), Florida Statutes (2007).
Complaint – Residential Eviction [Form #5] -
Fill in parties’ names in the space provided (the Plaintiff(s) is/are the party initiating
this action and the Defendant is the party against whom the case is initiated).
Read each line and fill in the appropriate response.
Date and sign in the space provided and print your name, address and telephone number.
Attach the written agreement to pay rent, if any.
Attach the Notice from Landlord to Tenant – Termination for Failure to Pay Rent [Form #1].
Civil Cover Sheet
[Form #1.997] -
Fill in the names of Plaintiff(s) and Defendant(s).
Check all that apply, if applicable.
Date and sign the cover sheet.
Authorization of Property Manager
[Form #COCIV 87] -
Fill in the names of Plaintiff(s) and Defendant(s).
Read each line and fill in the appropriate response.
The landlord must print and sign their name on this form.
NOTE: In order for a property manager to file a complaint on behalf of a landlord for uncontested residential
eviction, the property manager must attach to the complaint the landlord’s written authorization for the
property manager to act on the landlord’s behalf. This authorization must be limited to the completion,
signing, and filing of the pleadings necessary to evict a tenant for the nonpayment of rent.
SOURCE: Administrative Order 2006-070
3/2011 (Page 1 of 3) Residential Eviction for Non-Payment of Rent
Summons on Claim for Possession of Residential Premises [Form #7] -
Fill in the names of Plaintiff(s) and Defendant(s).
Provide the name and address of the party being served (Defendant). Only one
Defendant per summons.
Provide the name and address of the serving party (Plaintiff(s)).
The Clerk will date, sign and seal if all of the requirements have been fulfilled.
Nonmilitary Affidavit
[Form #81] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Read each line and select and/or fill in the appropriate response.
Date and sign in the presence of a Notary Public or Deputy Clerk.
Motion for Clerk’s Default – Residential Eviction
[Form #76] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Fill in the name of the party a default will be entered against (Defendant).
Date and sign in the space provided and print your name, address and telephone number.
The Clerk will date and sign if all of the requirements have been fulfilled.
Motion for Court’s Default – Residential Eviction [Form #COCIV 78] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Fill in the name of the party a default will be entered against (Defendant).
Date and sign in the space provided and print your name, address and telephone number.
The Judge will date and sign if all of the requirements have been fulfilled.
Motion for Default Final Judgment – Residential Eviction [Form #78] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Fill in the name of the party you are requesting a default against (Defendant).
Fill in the date of the default entered by the Clerk, if available.
Date and sign in the space provided and print your name, address and telephone number.
Motion/Order Setting Cause for Non-Jury Trial – Final Judgment [Form #10] -
Fill in the reference number and the names of Plaintiff(s) and Defendant(s).
Date and sign in the space provided and print your name, address and telephone number.
Fill in the names and addresses of all parties that will receive a copy.
Once completed the Judicial Assistant will fill in the hearing information, and the
Judge will date and sign if all of the requirements have been fulfilled.
Final Judgment – Residential Eviction [Form #66] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Read each line and fill in the appropriate response.
Fill in the name and addresses of all parties that will receive a copy.
The Judge will sign and date if all of the requirements have been fulfilled.
Writ of Possession
[Form #11] -
Fill in the reference number and the names of Plaintiff(s) and Defendant(s).
Fill in the name of the Defendant(s)
Fill in the property description
Fill in the name of the party receiving possession (Plaintiff(s)).
The Clerk will date, sign and seal if all of the requirements have been fulfilled.
3/2011 (Page 2 of 3) Residential Eviction for Non-Payment of Rent
3/2011 (Page 3 of 3) Residential Eviction for Non-Payment of Rent
Instructions for Writ of Possession form**:
The Writ of Possession should be delivered to the Clerk of the Court after the court enters the final judgment
evicting the tenant. The Clerk will sign this writ. After the Clerk signs the writ, it must be delivered to the
sheriff to be served upon the tenant and, if necessary, to forcibly evict the tenant after 24 hours from the time
of service.
If requested by the Landlord to do so, the Sheriff shall stand by to keep the peace while the Landlord changes
the locks and removes personal property from the premises. When such a request is made; the Sheriff may
charge a reasonable hourly rate, and the person requesting the Sheriff to stand by to keep the peace shall be
responsible for paying the reasonable hourly rate set by the Sheriff.
SOURCE: Section 83.62, Florida Statutes (2007)
Motion/Order to Disburse Funds From Registry of the Court [Form #13] -
Fill in the reference number and names of Plaintiff(s) and Defendant(s).
Date and sign in the space provided and print your name, address and telephone number.
The Judge will sign and date if all of the requirements have been fulfilled.
Disclosure from Nonlawyer [Form #14] -
Read each line and select and/or fill in the appropriate response.
Both persons should sign in the space provided.
Notice of Voluntary Dismissal
[Form #15] -
Fill in the reference number and names of Plaintiff(s) and
Defendant(s).
Fill in the name of the person dismissing the action (Plaintiff(s)).
Provide the name and address of the party being served, select the type of service used
and the date it was perfected.
Date and sign in the space provided, print your name, address and telephone number.
Notice from Landlord of Intent to Impose Claim on Security Deposit [Form #12] -
Print the name, address and telephone number of the tenant.
Read each line and select and/or fill in the appropriate response.
Date and sign in the space provided, print your name, address and telephone number.
Instructions for Form 12**:
A Landlord must return a Tenant's security deposit, together with interest if otherwise required, to the Tenant
no more than 15 days after the Tenant leaves the leased property. The Landlord may claim all or a portion of
the security deposit only after giving the Tenant written notice, by certified mail to the Tenant's last known
mailing address, of the Landlord's intention to keep the deposit and the reason for keeping it. The Landlord’s
notice must be sent within 30 days of the date Tenant vacates the leased property. If the Landlord does not
send the notice within the 30-day period the Landlord can keep the security deposit.
If the Tenant does not object to the notice within 15 days after receipt of the Landlord’s notice of intention to
impose a claim on the deposit, the Landlord may then keep the amount stated in the notice and must send the
rest of the deposit to the Tenant within 30 days after the date of the notice.
SOURCE: Section 83.49(3) Florida Statutes (200 7)
**FORM INSTRUCTIONS FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT
COMPLETELY DESCRIBE REQUIREMENTS OF FLORIDA LAW. YOU SHOULD CONSULT AN
ATTORNEY AS NEEDED.
(Form 1.997 Civil Rules of Procedure 1/2010)
CIRCUIT COURT, PINELLAS COUNTY, FLORIDA
CIVIL DIVISION
CIVIL COVER SHEET
The civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other
papers as required by law. This form shall be filed by the plaintiff or petitioner for the use of the Clerk of Court for the purpose of
reporting judicial workload data pursuant to Florida Statutes section 25.075. (See instructions for completion.)
I. CASE STYLE
Plaintiff
Case #:
Judge:
vs.
Defendant
II. TYPE OF CASE
(If the case fits more than one type of case, select the most definitive category.)
If the most descriptive label is a subcategory (is indented under a broader category), place an x in both the
main category and subcategory boxes.
Condominium
Contracts and indebtedness (Eviction/Delin Tenant)
Eminent domain
Auto negligence
Negligence—other
Business governance
Business torts
Environmental/Toxic tort
Third party indemnification
Construction defect
Mass tort
Negligent security
Nursing home negligence
Premises liability—commercial
Premises liability—residential
Products liability
Real property/Mortgage foreclosure
Commercial foreclosure $0 - $50,000
Commercial foreclosure $50,001 - $249,999
Commercial foreclosure $250,000 or more
Homestead residential foreclosure $0 - $50,000
Homestead residential foreclosure $50,001 - $249,999
Homestead residential foreclosure $250,000 or more
Non-homestead residential foreclosure $0 - $50,000
Non-homestead residential foreclosure $50,001 - $249,999
Non-homestead residential foreclosure $250,000 or more
Other real property actions $0 - $50,000
Other real property actions $50,001 - $249,999
Other real property actions $250,000 or more
Professional malpractice
Malpractice—business
Malpractice—medical
Malpractice—other professional
Other
Antitrust/Trade regulation
Business transactions
Constitutional challenge—statute or
ordinance
Constitutional challenge—proposed
amendment
Corporate trusts
Discrimination—employment or other
Insurance claims
Intellectual property
Libel/Slander
Shareholder derivative action
Securities litigation
Trade secrets
Trust litigation
✔
III. REMEDIES SOUGHT (check all that apply):
monetary;
nonmonetary declaratory or injunctive relief;
punitive
IV. NUMBER OF CAUSES OF ACTION
: [ ]
(specify)
V. IS THIS CASE A CLASS ACTION LAWSUIT
?
yes
no
VI. HAS NOTICE OF ANY KNOWN RELATED CASE BEEN FILED
?
no
yes If “yes,” list all related cases by name, case number, and court.
VII. IS JURY TRIAL DEMANDED IN COMPLAINT
?
yes
no
I CERTIFY that the information I have provided in this cover sheet is accurate to the best of my knowledge
and belief.
Signature
Fla. Bar #
Attorney or party (Bar # if attorney)
(type or print name) Date
(Form 1.997 Civil Rules of Procedure 1/2010)
CO CIV 87
IN THE COUNTY COURT OF THE SIXTH JUDCIAL CIRCUIT,
IN AND FOR PINELLAS COUNTY, FLORIDA
PLAINTIFF(S)
____________________________/
VS.
DEFENDANT (S)
____________________________/
AUTHORIZATION OF PROPERTY MANAGER
TO WHOM IT MAY CONCERN:
_____________________________________
is being retained by
_____________________________________, Landlord, as Property
Manager for the residential property located at
_______________________________________________________
_______________________________________________________.
The Property Manager is hereby authorized by the undersigned Landlord to act
on their behalf regarding uncontested residential tenant evictions. This
authorization must be limited to the completion, signing and filing of the
pleadings necessary to evict a tenant for the nonpayment of rent.
I hereby swear or affirm under the penalty of perjury that the foregoing is true
and accurate.
________________________________
Signature of Landlord
________________________________
Printed Name of Landlord
Form 1
NOTICE FROM LANDLORD TO TENANT--TERMINATION
FOR FAILURE TO PAY RENT
To:
Tenant’s Name
Address
City, State, Zip Code
From:
Date:
You are hereby notified that you are indebted to me in the sum of $ __________________ [insert amount
owed by Tenant] for the rent and use of the premises located at __ _______________________________, Florida
[insert address of p remises, including county], now occ upied by you and that I dem and payment of the rent or
possession of th e premises within three days (ex cluding Saturday, Sunday and legal holidays) from th e date of
delivery of this notice to-wit: on or before the ___ day of ____________, 20___ [insert the date which is three days
from the delivery of this notice, excluding the date of delivery, Saturday, Sunday and legal holidays].
_____________________________________
Signature
_____________________________________
Name of Landlord/Property Manager
[circle one]
______________________________________
Address [street address where Tenant can deliver rent]
______________________________________
City, State, Zip Code
______________________________________
Phone Number
Hand Delivered On
Posted On
Approved for use under rule 10-2.1(a) of
the Rules Regulating The Florida Bar
The Florida Bar 2010
This form was completed
with the assistance of:
Name:
Address:
Telephone Number:
IN THE COUNTY OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
UCN:
Case No.
-vs-
Plaintiff(s)
Defendant(s)
COMPLAINT FOR EVICTION
Plaintiff
, sues
Defendant ,
and alleges:
1. This is an action to evict a tenant from real property in Pinellas, Florida
2. Plaintiff owns the following described real property in the county:
3. Defendant has possession of the property under an oral written agreement to
pay rent of $ payable weekly monthly other .
A copy of the written agreement, if any, is attached as Exhibit “A”.
4. Defendant failed to pay rent due .
5. Plaintiff served defendant with a notice on to pay the rent or deliver
possession, but defendant refuses to do either. A copy of the notice is attached as Exhibit "B".
WHEREFORE, plaintiff demands judgment for possession of the property against the defendant.
Signature:
Name [print]:
Address:
City,
State,
Zip
Code:
Telephone:
Approved for use under rule 10-2.1(a) of This form was completed
the Rules Regulating The Florida Bar with the assistance of:
Name:
The Florida Bar 2010 Telephone Address:
IN THE COUNTY COURT, IN AND FOR
___________________________________ COUNTY, FLORIDA
[insert county in which rental property is located]
___________________________________
[insert name of Landlord]
Plaintiff,
vs.
___________________________________
[insert name of Tenant]
Defendant.
/
CASE NO. _____________________________
[insert case number assigned by
Clerk of the Court]
EVICTION SUMMONS - RESIDENTIAL
TO: ______________________________________________________________________________________
[insert name, address, and phone
numb
er of Tenant].
PLEASE READ CAREFULLY
You are being sued by _______________________________________________________________________
[insert Landlord's name]
to require you to move out of the property
located at ____________________________________________________
for the reasons given in the attached complaint.
You are entitled to a trial to decide whether you can be required to move, but you MUST do ALL of the
things listed below. You must do them within 5 days (not including Saturday, Sunday or legal holidays) after the
date these papers were given to you or to a person who lives with you or were posted at your home.
THE THINGS YOU MUST DO TO CHALLENGE THE EVICTION ARE AS FOLLOWS:
1. Write down the reason(s) why you think you should not be forced to move. The written reason(s)
must be given to the Clerk of Court at 315 COURT STREET, ROOM 170, CLEARWATER, FL 33756.
2. Mail or take a co py of yo ur written reason(s) to: _________________________________________
[insert Landlord's name and address]. ______________________________________________________________
3. Give the Clerk of Court the rent that is due. You MUST pay the Clerk the rent each time it becomes
due until the lawsuit is over. Whether you win or lose the lawsuit, the Judge may pay this rent to the Landlord. [By
statute, public housing tenants or tenants receiving rent subsidies shall be required to deposit only that portion of the
full rent for which the tenant is respo nsible pursuant to federal, state, or local program in which they are
participating.]
4. If you and the Landlord do not agree on the amount of rent owed, you must file a written re quest
(motion) which asks the Judge to decide how much money you must give to the Clerk of Court. The written request
must be filed with your answer to the Eviction Complaint. A copy of your motion must also be mailed or hand
delivered to the plaintiff(s) attorney, or if the Plaintiff(s) has no attorney, to the Plaintiff.
5. If the attached complaint also contains a claim for money damages (such as unpaid rent), you must respond
to that claim separately. You must write down the reasons why you believe that you do not owe the money claimed. The written
reasons must be given to the clerk of the court at the address specified in paragraph (1) above, and you must mail or give a
copy of your written reasons to the plaintiff/plaintiff’s attorney at the address specified in paragraph (2) above. This must be
done within 20 days after the date these papers were given to you or to a person who lives with you.
This obligation is separate from the requirement of answering the claim for eviction within 5 working days after these papers
were given to you or to a person who lives with you or were posted at your home.
MONIES DEPOSITED INTO THE REGISTRY OF THE COURT MUST BE IN THE FORM OF CASH, CASHIERS
CHECK, OR MONEY ORDER. A CLERK’S FEE OF 3% ON THE FIRST $500.00, AND 1.5% ON EACH
SUBSEQUENT $100.00 MUST BE PAID IN ADDITION TO THE MONIES DEPOSITED.
FORM 7
PINELLAS
IF YOU DO NOT DO ALL OF THESE THINGS WITHIN 5 DAYS (NOT INCLUDING SATURDAYS,
SUNDAYS, AND LEGAL HOLIDAYS FOR YOUR COURTHOUSE) YOU MAY BE EVICTED WITHOUT A
HEARING OR FURTHER NOTICE.
THE STATE OF FLORIDA:
TO EACH SHERIFF OF THE STATE:
You are commanded to serve this Summons and a copy of the Complaint in th is lawsuit on the above-
named Defendant.
DATED on the ________ day of ____________________, 20___
KEN BURKE, Clerk of the Court
By: __________________________________
FORM 7
Depu
ty Clerk
Approved for use under rule 10-2.1(a) of
the Rules Regulating The Florida Bar
The Florida Bar 2010
This form was completed
with the assistance of:
Name:
Address:
Telephone Number:
315 Court Street, Room 170
Clearwater, FL 33756
NOTIFICACION DE DESALOJO/RESIDENCIAL SIRVASE LEER CON CUIDADO
Usted esta siendo demandado por .................... para exigirle que desaloje el lugar donde reside por los moti-vos que se expresan
en la demanda adjunta.
Usted tiene derecho a ser sometido a juicio para determinar si se le puede exigir que se mude, pero ES NE-CESARIO que haga
TODO lo que se le pide a continuacion en un plazo de 5 dias (no incluidos los sabados, domingos, ni dias feriados) a partir de la
fecha en que estos documentos se le entregaron a usted o a una persona que vive con usted, o se colocaron en su casa.
USTED DEBERA HACER LO SIGUIENTE:
(1) Escribir el (los) motivo(s) por el (los) cual(es) cree que no se le debe obligar a mudarse. El (Los) moti-vo(s) debera(n)
entregarse por escrito al secretario del tribunal en el Pinellas County Courthouse, 315 Court Street, Room 170, Clearwater, FL
33756
(2) Enviar por correo o darle su(s) motivo(s) por escrito a: . ......................................................... .
.
(3) Pagarle al secretario del tribunal el monto del alquiler que la demanda adjunta reclama como adeudado, asi como cualquier
alquiler pagadero hasta que concluya el litigio. Si usted considera que el monto reclamado en la demanda es incorrecto, debera
presentarle al secretario del tribunal una mocion para que el tribunal deter-mine el monto que deba pagarse. Si usted presenta una
mocion, debera adjuntarle a esta cualesquiera documen-tos que respalden su posicion, y enviar por correo o entregar una copia de
la misma al demandante/abogado del demandante.
(4) Si usted presenta una mocion para que el tribunal determine el monto del alquiler que deba pagarse al se-cretario del tribunal,
debera comunicarse de inmediato con la oficina del juez al que se le haya asignado el caso para que programe una audiencia con
el fin de determinar el monto que deba pagarse al secretario del tribunal mientras el litigio este pendiente.
SI USTED NO LLEVA A CABO LAS ACCIONES QUE SE ESPECIFICAN ANTERIORMENTE EN UN PLAZO DE 5 DIAS
LABORABLES A PARTIR DE LA FECHA EN QUE ESTOS DOCUMENTOS SE LE ENTREGARON A USTED O A UNA
PERSONA QUE VIVE CON USTED, O SE COLOQUEN EN SU CA-SA, SE LE PODRA DESALOJAR SIN NECESIDAD
DE CELEBRAR UNA AUDIENCIA NI CURSAR-SELE OTRO AVISO
(5) Si la demanda adjunta tambien incluye una reclamacion por danos y perjuicios pecunarios (tales como el incumplimiento de
pago del alquiler), usted debera responder a dicha reclamacion por separado. Debera expon-er por escrito los motivos por los
cuales considera que usted no debe la suma reclamada, y entregarlos al secre-tario del tribunal en la direccion que se especifica
en el parrafo (1) anterior, asi como enviar por correo o entre-gar una copia de los mismos al demandante/abogado del
demandante en la direccion que se especifica en el parrafo (2) anterior. Esto debera llevarse a cabo en un plazo de 20 dias a partir
de la fecha en que estos docu-mentos se le entregaron a usted o a una persona que vive con usted. Esta obligacion es aparte del
requisito de responder a la demanda de desalojo en un plazo de 5 dias a partir de la fecha en que estos documentos se le en-
tregaron a usted o a una persona que vive con usted, o se coloquen en su casa.
CITATION D‘EVICTION/RESIDEN LISEZ ATTENTIVEMENT
Vous etes poursuivi par .................... pour exiger que vous evacuez les lieux de votre residence pour les rai-sons enumerees dans
la plainte ci-dessous.
Vous avez droit a un proces pour determiner si vous devez demenager, mais vous devez, au prealable, suivre les instructions
enumerees ci-dessous, pendant les 5 jours (non compris le samedi, le dimanche, ou un jour ferie) a partir de la date ou ces
documents ont ete donnes a vous ou a la personne vivant avec vous, ou ont ete affiches a votre residence.
LISTE DES INSTRUCTIONS A SUIVRE:
(1) Enumerer par ecrit les raisons pour lesquelles vous pensez ne pas avoir a demenager. Elles doivent etre remises au clerc du
tribunal a Pinellas County Courthouse, 315 Court Street, Room 170, Clearwater, FL 33756
(2) Envoyer ou donner une copie au:
.. .
(3) Payer au clerc du tribunal le montant des loyers dus comme etabli dans la plainte et le montant des loyers dus jusqu‘a la fin
du proces. Si vous pensez que le montant etabli dans la plainte est incorrect, vous devez pre-senter au clerc du tribunal une
demande en justice pour determiner la somme a payer. Pour cela vous devez attacher a la demande tous les documents soutenant
votre position et faire parvenir une copie de la demande au plaignant/avocat du plaignant.
(4) Si vous faites une demande en justice pour determiner la somme a payer au clerc du tribunal, vous devrez immediatement
prevenir le bureau de juge qui presidera au proces pour fixer la date de l‘audience qui decidera quelle somme doit etre payee au
clerc du tribunal pendant que le proces est en cours.
SI VOUS NE SUIVEZ PAS CES INSTRUCTIONS A LA LETTRE DANS LES 5 JOURS QUE SUIVENT LA DATE OU CES
DOCUMENTS ONT ETE REMIS A VOUS OU A LA PERSONNE HABITANT AVEC VOUS, OU ONT ETE AFFICHES A
VOTRE RESIDENCE, VOUS POUVEZ ETRE EXPULSES SANS AU-DIENCE OU SANS AVIS PREALABLE 112
(5) Si la plainte ci-dessus contient une demande pour dommages pecuniaires, tels des loyers arrieres, vous devez y repondre
separement. Vous devez enumerer par ecrit les raisons pour lesquelles vous estimez ne pas devoir le montant demande. Ces
raisons ecrites doivent etre donnees au clerc du tribunal a l‘adresse specifiee dans le paragraphe (1) et une copie de ces raisons
donnee ou envoyee au plaignant/avocat du plaignant a l‘adresse specifiee dans le paragraphe (2). Cela doit etre fait dans les 20
jours suivant la date ou ces documents ont ete presentes a vous ou a
la personne habitant avec vous, ou affiches a votre
residence.
IN THE COUNTY COURT, IN AND FOR
__________________ COUNTY, FLORIDA
_
__________________________________
[insert name of Landlord]
Plaintiff,
vs.
___________________________________
[insert name of Tenant]
Defendant.
/
CASE NO. _________________________
NONMILITARY AFFIDAVIT
On this day personally appeared before me, the undersigned authority, ______________________________,
who, after being first duly sworn, says:
Defendant, _____________________________, is kno wn by Affiant not to be in the military service or
any governmental agency or branch subject to the provisions of the Soldiers' and Sailors' Civil Relief Act.
DATED: __________________________________ ______________________________________
Signature of Affiant
N
am
e: ________________________________
Address: ______________________________
______________________________________
Telephone No. _________________________
Sworn and subscribed before me on _______________________ [date], by
__________________________ [name], who _____ is p ersonally known to me ______ produced
________________________ [document] as identification and who took an oath.
____________________________________
NOTARY PUBLIC-STATE OF FLORIDA
Name: ______________________________
Commission No. ______________________
My Commission Expires: _______________
I CERTIFY that I ____ mailed, ____ faxed and mailed, or ____ hand delivered a copy of this motion and
attached affidavit to the Defendant at _______________________________________________________________
[insert address at which Tenant was served and fax number if sent by fax].
Name ____________________________
Address __________________________
Fax No. _______________________
Approved for use under rule 10-2.1(a) of This form was completed
the Rules Regulating The Florida Bar with the assistance of:
Name:
The Florida Bar 2010 Address:
Telephone Number:
PINELLAS
Form 81
IN THE COUNTY COURT, IN AND FOR
_________________________ COUNTY, FLORIDA
CASE NO.: _______________________________
_____________________________________ ,
(Insert name of Landlord)
Plaintiff,
vs. MOTION FOR CLERK'S DEFAULT--
RESIDENTIAL EVICTION
_____________________________________ ,
(Insert name of Tenant)
Defendant.
_____________________________________ /
Plaintiff asks the clerk to enter a d efault against _____________________________ , D efendant,
for failing to respond as required by law to plaintiff’s complaint for residential eviction.
Signature __________________________________
Name _________________________________
Address _______________________________
_________________________________
Telephone Number _______________
DEFAULT ----- RESIDENTIAL EVICTION
A default is entered in this action against the Defendant for eviction for failure to respond as required
by law.
DATE: ___________________________ CLERK OF THE COURT
By: _________________________________
Deputy Clerk
cc: _______________________________________
(Insert name of Landlord)
_________________________________________
(Insert name and address of Tenant)
This form was completed
Approved for use under rule 10-2.1(a) of with the assistance of:
The Rules Regulating The Florida Bar Name:
Address:
The Florida Bar 2010 Telephone Number:
FORM 76
PINELLAS
IN THE COUNTY COURT IN AND FOR PINELLAS COUNTY, FLORIDA
CIVIL DIVISION
__________________________________ , CASE NO. ___________________
(
Insert name of Landlord) DIVISION: ___________________
Plaintiff,
vs.
__________________________________
(
Insert name of Tenant)
Defendant,
MOTION FOR COURT DEFAULT
Plaintiff moves for entry of a default by the Court because the Defendant ____________BBBBBB____
_________________________________ failed to place the rent money into the Registry of the Court
as required by law.
Signature ________________________
Landlord/Plaintiff
DEFAULT
A default is entered in this action against the Defendant, ______________________________________ ,
named in foregoing Motion for failure to deposit the rent money into the Registry of th
e Court as required
by law.
DONE AND ORDERED in Pinellas County, Florida this _____ day of___________________,
____________________________________________
County Judge
Form CO CIV 78
IN THE COUNTY COURT, IN AND FOR
_______________________________ COUNTY, FLORIDA
CASE NO.: ______________________________
(insert case number assigned
by Clerk of the Court)
________________________________________ ,
(Insert name of Landlord)
Plaintiff,
vs. MOTION FOR DEFAULT FINAL
JUDGMENT-RESIDENTIAL EVICTION
_______________________________________
(Insert name of Tenant)
Defendant.
_________________________________________ /
Plaintiff asks the court to enter a Default
Final Judgment against _________BBBBB___________
[name]
Defendant, for residential eviction and says:
1. Plaintiff filed a complaint alleging grounds for residential eviction of Defendant.
2. A Default was entered by the Clerk of this Court on____________________________
[date]
WHEREFORE, Plaintiff asks this Court to enter a Final Judgment For Residential Eviction
against Defendant.
Signature____________________________________
Name ______________________________
Address ___________________________
____________________________________
Telephone Number _________________
cc: ______________________________________
(Insert name and address of Tenant)
This form was completed
Approved for use under rule 10-2.1(a) of with the assistance of:
the Rules Regulating The Florida Bar Name:
Address:
The Florida Bar 2011 Telephone Number:
FORM 78
PINELLAS
Residential Eviction for Non-Payment of Rent Form #10
IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
Reference No: ______________________ UCN: 5220 CC XXCOCO
_______________________________
Plaintiff(s)
vs.
_______________________________
Defendant(s)
MOTION TO SET CAUSE FOR NON-JURY TRIAL
FINAL JUDGMENT RESIDENTIAL EVICTION
Plaintiff(s) asks the court to set the above-styled cause for a non-jury trial on the Final Judgment for Residential
Eviction.
Date: ____________________
Signature of Plaintiff(s)
Print Name:
Address:
City, State, Zip:
Telephone No:
ORDER SETTING CAUSE FOR NON-JURY TRIAL
FINAL JUDGMENT RESIDENTIAL EVICTION
The Court having reviewed the file and pleadings therein and being otherwise fully advised in the premises, it is
therefore
ORDERED AND ADJUDGED that the non-jury trial on the Final Judgment for Residential Eviction is set for a
hearing before Judge__________________________ on {date} ______________________, at
{time} ____________, in Room ____________ of the Pinellas County Courthouse located at:
_____________________________________________________________________________________________.
________hour(s)/________minutes have been reserved for this hearing.
DONE AND ORDERED in Pinellas County, Florida on the _______ day of _____________, 20_______.
_________________________________
cc: COUNTY COURT JUDGE
Plaintiff(s) __________________________
Address ____________________________
City, State, Zip_______________________
Defendant(s) ________________________
Address ____________________________
City, State, Zip_______________________
If you are a person with a disability who needs any accommodation in order to
participate in this proceeding, you are entitled, at no cost to you, to the provision
of certain assistance. Please contact the Human Rights Office, 400 S. Ft. Harrison
Ave., Ste. 300, Clearwater, FL 33756, (727)464-4062 (V/TDD) at least 7 days
before your scheduled court appearance, or immediately upon receiving this
notification if the time before the scheduled appearance is less than 7 days; if you
are hearing or voice impaired, call 711.
FORM 10 - 3/2011
IN THE COUNTY COURT, IN AND FOR
_________________________________________
(insert county in which rental property is located)
COUNTY, FLORIDA
CASE NO.: _______________________________
(insert case number assigned
by Clerk of the Court)
________________________________________ ,
(Insert name of Landlord)
Plaintiff,
vs. FINAL JUDGMENT - EVICTION
_________________________________________ ,
(Insert name of Tenant)
Defendant.
_________________________________________ /
THIS ACTION came before the Court upon Plaintiffs Complaint for eviction. On the ev idence
presented, it is
ADJUDGED that Plaintiff, _______________________________________ , recover from Defendant,
(insert Landlord's name)
________________________________________ possession of the real property described as follows:
(insert Tenant's name)
__________________________________________________________________________________
(insert legal or street description of rental premises including, if applicable, unit number)
and $ ________________ as court costs, for WHICH LETS WRITS OF POSSESSION AND EXECUTIONS
NOW ISSUE.
ORDERED in ________________________________ , __________________________________
(insert city in which court is located) (insert county in which court is located)
COUNTY, FLORIDA on ___________________________ , 20 _____ .
_________________________________________
(County/Circuit) Judge
cc: _____________________________________
(Insert name of Landlord)
_____________________________________
(Insert name of Tenant)
This form was completed
with assistance of:
Name:
Approved for use under rule 10-1.1(b) of Address:
the Rules Regulating The Florida Bar Telephone Number:
The Florida Bar 2010
FORM 66
PINELLAS
RESIDENTIAL PROPERTY
COUNTY COURT, PINELLAS COUNTY, FLORIDA
CIVIL DIVISION
UCN: REF. NO.
Plaintiff,
vs.
Defendant.
WRIT OF POSSESSION
THE STATE OF FLORIDA:
TO ALL AND SINGULAR THE SHERIFFS OF THE STATE:
YOU ARE COMMANDED to remove all persons from the following property in Pinellas County,
Florida AFTER A 24 HOUR NOTICE HAS BEEN CONSPICUOUSLY POSTED ON THE PREMISES:
and to put
In full possession thereof.
WITNESS my hand and seal of the Court on day of , 20
KEN BURKE
Clerk of the Circuit Court
By:
Deputy Clerk
(SEAL)
Plaintiff(s) – or – Attorney’(s) Name and Address
Phone # :
FORM 11 - COCIV 12
IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
Reference No: ______________________
__________________________
Plaintiff(s)
vs.
___________________________
Defendant(s)
MOTION TO DISBURSE FUNDS FROM REGISTRY OF THE COURT
Plaintiff(s) asks the Court to direct the Clerk to disburse all the funds being held in the
Registry of the Court.
Date: __________________
Signature of Plaintiff(s)
Print Name:
Address:
City, State, Zip:
Telephone No:
ORDER TO DISBURSE FUNDS FROM REGISTRY OF THE COURT
The Court having reviewed the file and pleadings therein and being otherwise fully advised
in the premises, it is therefore
ORDERED AND ADJUDGED that the Clerk of the Court is hereby directed to disburse
all the funds held in the Registry of the Court to the Plaintiff.
DONE AND ORDERED in Pinellas County, Florida on the _______ day of
______________, 20_______.
________________________________
COUNTY COURT JUDGE
cc:
Plaintiff(s) ________________________
Address __________________________
City, State, Zip_____________________
Defendant(s) ______________________
Address __________________________
City, State, Zip_____________________
Form 13 – 3/2011 Residential Eviction for Non-Payment of Rent
NONLAWYERS WHO ASSIST OTHERS IN COMPLETING FORMS
If a nonlawyer will help you in com pleting forms in this booklet, that person must provide you a
copy of the d isclosure on the bottom of this pa ge before beginning. Both you and the nonlawyer
helping you must sign the disclosure form. You should receive a copy to keep and the nonlawy er
helping you should keep a copy. This disclaimer does not act as or constitute a waiver, disclaim er,
or limitation of liability.
Anyone assisting you in completing these forms also must put their nam e, address, and telephone
number on the bottom of the last page of the fo rm. A space i s provided on each form for this
purpose.
DISCLOSURE
________________________________ told me that he/she is not a lawyer and may not give legal advice or
represent me in court.
________________________________ told me that he/she may only help me fill out a form approved by the
Supreme Court of Florida._______________________________ may only help me by asking me questions
to fill in the form. ________________________________ may also tell me how to file the form.
_________________________________ told me that he/she is not an attorney and cannot tell me what my
rights or remedies are or how to testify in court.
______ I can read English.
______ I cannot read English but this notice was read to me by _____________________________________
in ___________________________________ .
(language)
__________________________________
Signature
__________________________________
Signature
FORM 14 - 3/2011
IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
Reference No: ______________________
__________________________
Plaintiff(s)
vs.
___________________________
Defendant(s)
NOTICE OF VOLUNTARY DISMISSAL
Plaintiff(s), __________________________________, in the above styled cause hereby
submit this Notice of Voluntary Dismissal as this cause has been settled between parties.
I certify that a copy of this document was [√ one only] mailed faxed and mailed
hand delivered to the person(s) listed below on the _____ day of ______________, 20_____.
Defendant(s):________________________
Address:____________________________
City, State, Zip: ______________________
Dated: __________________
Signature of Plaintiff(s)
Print Name:
Address:
City, State, Zip:
Telephone No:
Form 15 3/2011 Residential Eviction for Non-Payment of Rent
(Tenant's Name and Address)
Dear ______________________________
(Tenant's Name)
This is a notice of my intention to impose a claim for damages in the amount of
$ ____________________________ upon your security deposit due to _____________________________
(insert amount of damages)
______________________________________________________________________________________
(insert damage done to premises or other reason for claiming security deposit)
This notice is sent to you as required by §83.49(3), Florida Statutes. You are hereby notified that you must
object inwriting to this deduction from your security deposit within 15 days from the time you receive this
notice or I
will b e authorized to deduct my clai m from your security deposit. Your objection must
be sent to
______________________________________________________________________________________
(insert Landlord's address)
Landlord's Name ____________________________________
Address ___________________________________________
Phone Number ______________________________________
Approved for use under rule 10-2.1(a) of
the Rules Regulating The Florida Bar
The Florida Bar 2010
This form was completed
with the assistance of
Name:
Address:
Telephone Number:
FORM 12
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Completed 10 February 2021

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