§ Form 11 Complaint for Negligence

Codes > Federal Rules of Civil Procedure > Appendix of > Form 11

Form 11. Complaint for Negligence

(Caption--See Form 1.)

    1. (Statement of Jurisdiction--See Form 7.)

    2. On date, at place, the defendant negligently drove a motor vehicle against the plaintiff.

    3. As a result, the plaintiff was physically injured, lost wages or income, suffered physical and mental pain, and incurred medical expenses of $_______.

    Therefore, the plaintiff demands judgment against the defendant for $_______, plus costs.