Fill and Sign the A Adult Resident Citizen of Form

IN THE CIRCUIT COURT OF COUNTY, MISSISSIPPI PLAINTIFF VS. CIVIL ACTION NO. DEFENDANT COMPLAINT Comes , a adult resident citizen of , , and brings this ac tion for self and on behalf of the heirs at law of , namely, , resident citiz ens of , , against the defendants, , adult resident citizens of County, Mississippi, and , whose name is unknown, but whose true name will be inserted by amendment when it is discovered; Plaintiff is ignorant of the name of the fictitious party at this tim e, and would show unto the court the following: Defendants, but 's profession is unknown but is believed to be that of a physician, are licensed physicians in the State of Mississippi. The matter in controversy exceeds, exclusive of interests and costs, the sum of Dollars, and the damages claimed are within the jurisdictional limits of the Circuit Court of   County, Mississippi. was the of and he/she of the other Plaintiffs herein and all of them together were the sole surviving heirs of . During , Defendant and   entered into a patient-doctor relationship and as direct and proximate result t hereof, lost his/her life through the medical negligence of and through the negligence of . lost his/her life on , by reason of the recklessness, carelessness and medi cal negligence of the Defendants, . As a proximate result of the negligence of the Defendants, Plaintiffs should be awarded damages for the following: 1. The loss of society and companionship of ; 2. The present net cash value at the time of the death of 's life expectancy; 3. Pain and suffering endured by prior to death; 4. All reasonable medical expenses incurred by and reasonable funeral expenses incurred by and/or the estate of All of which said damages are in excess of Dollars and are within the jurisdictional limits of this court. WHEREFORE, PREMISES CONSIDERED, Plaintiffs bring this action against the Defendants and demand judgment against in an amount within the jurisdictional limits of this Court and in excess of Ten Thousand Dollars. Respectfully submitted, this the day of , 20 . _______________________________________ ATTORNEYS FOR PLAINTIFF BY: