Fla. Sm. Cl. R. Form 7.336

(CAPTION)

STATEMENT OF CLAIMS FOR REPLEVIN

Plaintiff(s) sues Defendant(s) and alleges:

1. This is an action to recover possession of personal property.

2. The description of the property is

3. To Plaintiff’s best knowledge, information, and belief the value of

the property is $ and its location is

4. Plaintiff is the owner of the claimed property or is entitled to

possession of it by virtue of the following source of title, or right of possession:

(If interest is based on a written instrument a copy is attached.)

5. The property cannot be released by the defendant without a court

order, or the property is wrongfully detained by the defendant who obtained

possession by:

6. To Plaintiff’s best knowledge, information, and belief, defendant

detains property because:

7. The property has not been taken for any tax, assessment, or fine

pursuant to law, nor has it been taken under an execution or attachment

against plaintiff’s property, or if so taken, it is by law exempt from such taking

by the following reference to the exemption law relied upon:

8. Written demand for return of the property was provided to

Defendant and [if Defendant is not a municipality] also to the Department of

Financial Services at least 90 days prior to the filing of this Complaint. Section

768.28(6)(a), Florida Statutes. A copy of the demand is attached hereto.

9. The property is not contraband, was not the fruit of criminal

activity, and is not being held for some evidentiary purposes.

10. The property came into possession of Defendant on or about

…..(date)…..

11. Plaintiff has the legal right to possess the property and is not

subject to any legal prohibition against such possession.

Pursuant to section 92.525, Florida Statutes, under penalties of perjury,

I declare that I have read the foregoing Statement of Claim and the facts stated

in it are true.

Plaintiff

NOTE: This form is to be used by those seeking return of personal property

(including weapons) taken by a government entity for purposes other than for a

criminal investigation, as an incident to arrest, pursuant to a search warrant,

or any other seizure for which the Florida Statutes provide a specific procedure

for return. Rather, this form is for use by those who seek return of personal

property taken for other purposes, such as “safekeeping,” and for which the

Florida Statutes provide no procedures.