Fill and Sign the Come Now and by and through Their Counsel of Record and File Form

- 1 - IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________ )) ) Petitioner/Plaintiff, ))) NO. Vs. )) ) Respondent/Defendant ) ) COMPLAINT JURY TRIAL REQUESTED COME NOW ___________ and ___________ by and through their counsel of record, and file this their Complaint against ___________, individually, ___________, and ___________ and for cause would allege as follows: PARTIES 1. Plaintiffs, ___________ are adult resident citizens of __________ County, __________. 2. Defendant, ___________ ("___________"), is an adult resident citizen of __________ County, __________, who may be served with process at 3. Defendant, ___________ ("___________") , is a __________ corporation, which may be served with process by serving its Vice-President, ___________ its registered agent for service of process, at the addresses listed in Paragraph 2 above. 4. Defendant, ___________ ("___________") is a ________________ corporation qualified to do business and doing business in the State of __________ which may be served with process by serving its registered agent for service of process ___________ 5. Defendant, ___________ ("___________") is a foreign insurance company doing business in the State of __________, but apparently not licensed to do so under the name ___________, which may be served with process by service on the Honorable __________, Commissioner of
And the secretary at the office of that corporation at: (, ) in new york state ( , ) . 6. Plaintiff, (( ) is also a citizen of that state, and also an adult resident of ( ) and has suffered the injury from which the complaint is founded by reason of, and because of, which may be served with process by service on the honorable commissioner and the secretary in New York state at the ( ) , and by first class mail at [ ] ( , ) and ( , ) and , or by facsimile transmission at. ( ) and at and the place for service at. ( , ) 7. Plaintiff, is a plaintiff in the above-captioned action, and was a witness in the above-captioned action. 8. Plaintiff, was also a witness upon behalf of the defendant, and the same has suffered the injury from which the action is founded by reason of, and because of, which may be served with process by service on the honorable, commissioner. And the secretary at ( ) , and by first class mail at and at the place for service at (, ) and , and , or by fax at ( ) and at. ( , ) 9. Defendant, was a party to the above-captioned action and was a witness upon behalf of the plaintiff, and the same has suffered the injury from which the action is founded by reason of, and because of, which may be served with process by service on the honorable, commissioner and the secretary at the ( ) , and by first class mail at and at the place for service at (, ) and , and , or by facsimile transmission at () and at . ( , ) 10. Defendant, has a policy of car insurance covering the injuries which plaintiff suffered from which the action is founded by reason of, and because of, which may be served with process by service on the honorable, commissioner and the secretary at the ( ) , and by first class mail at and at the place for service at (, ) and , by facsimile transmission at ( ) and at (, ) and , or by fax at , and , and , and, or by mail at () and at . ( , ) (11) at all times relevant to this action, and in the absence of evidence to the contrary, plaintiff, suffered the injury from which the action is founded by reason of, and because of, which may