§ Form 4.10 Complaint for Negligence, Including Allegation That Plaintiff Is Unable to Determine Definitely Which of Several Persons Is Responsible
Form 4.10 Complaint for Negligence, Including Allegation That Plaintiff Is Unable to Determine Definitely Which of Several Persons Is Responsible
(State and County) [FN1] (Court and docket information) [FN2]
(CAPTION) COMPLAINT
THE PLAINTIFF ALLEGES:
1. On or about (date) Defendant C.D. or E.F., or both of them, operated their cars in a negligent manner.
2. The negligence of Defendants caused their cars to collide in the intersection of _______ and _______, in the town of Falmouth, Cumberland County, Maine.
3. As a result of the defendants' negligence plaintiff suffered injuries and damages, including: (describe injuries or damages); [pain and suffering;]/[reasonable and necessary medical expenses;]/[loss of wages;]/[property damage;]/[and]/[(describe other damages, if any) ].
4. As a further result Plaintiff will suffer and incur additional damages in the future, including, but not limited to: [pain;]/ [suffering;]/[loss of wages,]/[reasonable and necessary medical expenses;]/[and]/[ (describe other future or continuing damages, if any) ] in such amounts as shall be proven at trial.
5. [FN3] Plaintiff's claim is within the jurisdictional limits of this court.
WHEREFORE, Plaintiff demands judgment against the Defendant(s) in an amount [sufficient to fairly and reasonably compensate [him/her] for all past [and future] injuries and damages]; plus plaintiff's costs and interest.
(date and signature block) [FN4]
[FN1] See Section 2.
[FN2] See Section 2, supra.
[FN3] Jurisdictional allegation for actions filed in District Court.
[FN4] See Section 1, supra.