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Torts Personal Injury Complaint Form

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Submitted By ashnkevin83
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* * * ** * * ** * * ** * * ** * * * * IN THE Deirdre Jones
Plaintiff * CIRCUIT COURT
v. * FOR
JACK DANIELS * HYPOVILLE, CA
Defendant * FILE NO. 123456
* * * * * * * * * * * * * * ** * * *
COMPLAINT AND PRAYER FOR JURY TRIAL
Deirdre Jones, Plaintiff, by Margaret Smith, his attorney, sues the defendant
, Jack Daniels, and in
Support, states as follows:
PREAMBLE
1. Deirdre Jones, Plaintiff, is a resident of Fredonia.
2. Jack Daniels, Defendant, is a resident of Freedonia.
3. The Defendant regularly visits and is engaged in business in Freedonia.
4. This action arises from a theft and burglary attempt which occurred on May 22, 2000, on Freedonia Rd

.
STATEMENT OF FACTS
5. On May 22, 2000, the Plaintiff, Deirdre Jones, was Hanging out with friends and relaxing. When all of a sudden the defendant, Jack Daniels comes up from behind her and tries to take her purse.

6. At the same time, The Plaintiff, who is a 2 time Olympic gymnast runs after the defendant, catches up to him and takes back her purse The defendant, then, shouts a defamatory statement. "You stupid b----, drop dead!” The Plaintiff is very hurt by the defendant’s remarks. She notices when she arrives home that her wallet fell out during the struggle which caused her to lose $60.00 in cash and other personal items.
COUNT ONE
Plaintiff, Deirdre Jones alleges and incorporates by reference a
All those facts and allegations in
Paragraphs 1 through 6 above and further alleges:
7. The actions were caused by attempted burglary, verbal assault, and defamation of character and loss of wages caused by emotional distress. Of the Defendant,
Jack Daniels, for that among other acts and omissions the Defendant:
a. Took the pocket book
b. Got upset when pocket book was taken back.
c. Shouted obscenities at the plaintiff, Deirdre Jones

D. Caused her such emotional distress that caused her

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