§ Form 12 Complaint for Negligence when the Plaintiff Does Not Know Who is Responsible

Codes > Federal Rules of Civil Procedure > Appendix of > Form 12

Form 12. Complaint for Negligence when the Plaintiff Does Not Know Who is Responsible

(Caption--See Form 1.)

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

    2. On date, at place, defendant name or defendant name or both of them willfully or recklessly or negligently drove, or caused to be driven, a motor vehicle against the plaintiff.

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

    Therefore, the plaintiff demands judgment against one or both defendants for $_______, plus costs.