Fill and Sign the Complaint Bite Sample Form

IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________       ) )       ) Petitioner/Plaintiff, ) ) ) NO.       Vs. ) )       ) Respondent/Defendant ) ) COMPLAINT COMES NOW Plaintiffs, _______________, a minor, by and through Next of Friend, _______________ and _______________, individually, and _______________ and files this their Complaint against Defendants, _______________ and _______________ and for cause of action would show unto the Court the following, to-wit: 1. Plaintiff, _______________ is a minor and is in Court through his father and next friend, _______________. _______________ and _______________ are the natural parents of the minor, _______________. Plaintiffs are resident citizens of _______________ County, _______________, residing at _____________________________, _______________. 2. Defendants _______________ and _______________ are resident citizens of _______________ County, _______________, and may be served with process of this Court at ______________________________, _______________. 3. On or about the ______ day of ____________, 20___, at approximately ____ A.M., Plaintiff, _______________, was waiting at ______________________________, - 1 - _______________for the school bus to transport him to _______________ Elementary School, _______________, _______________, when, without warning or provocation, a full-grown combination Doberman Pinscher/German Shepherd dog attacked and injured said minor. The dog was unattended and owned by Defendants, _______________ and _______________. 4. That said dog had a propensity known to Defendants to bite and injure humans, which was unknown to Plaintiffs at the time of the attack. That Defendants should have kept the dog fenced or leashed and failed to do so thereby endangering Plaintiff, _______________, and other humans. 5. That Defendants had a duty to keep this dangerous animal away from Plaintiff or anyone else, but Defendants allowed the dog to roam free throughout the neighborhood terrorizing young children and in so doing breached their duty to keep the dog under control thereby proximately causing the injuries sustained by young _______________. 6. That as a direct and proximate cause of Defendant's negligence by failing to keep the aforesaid vicious dog under control or fenced, Plaintiffs have sustained serious and permanent injuries, to-wit: A. Past, present and future medical expenses for scaring and disfigurement to _______________’s face; B. Past, present and future psychological and psychiatric damages to _______________, _______________ and _______________; C. Past, present and future mental anguish and anxiety of all Plaintiffs; D. Permanent scarring of _______________’s face, and permanent scarring of his psychological make-up; and E. Out-of-pocket expenses and cost incurred in treating, attending and caring for - 2 - _______________. 7. That as a direct and proximate cause of Defendant's negligence, Plaintiffs have sustained injuries in the amount of at least $_______________; plus attorney's fee, pre-judgment and post judgment interest and all costs of Court. At all times Defendants, and each and all of them, knew and were well aware that such animal had a violent propensity to bite and attack persons without warning or provocation, yet Defendants failed to warn the Plaintiff of such animal's propensity or protect the Plaintiff from the vicious attack by such animal, and further failed to keep such animal on a leash or other restraint, and as a result, did encourage such animal to attack and bite the Plaintiff. As a direct result of such egregious conduct on the part of the Defendants, and their conscious disregard of the safety and health of the plaintiff, and the resultant injuries and damages caused by their conduct, Plaintiff is entitled to exemplary damages in an amount subject to proof at trial and not less than $_______________. WHEREFORE, PREMISES CONSIDERED, Plaintiffs, _______________, By and Through Next Of Friend, _______________ and _______________, Individually, and _______________, natural parents of _______________, a minor, sue and demand judgment of Defendants _______________ and _______________, jointly and severally, in the amount of at least $_______________ actual damages, punitive damages in the amount of $_______________, plus attorney's fee, pre-judgment and post judgment interest and all costs of Court. - 3 - Respectfully submitted, Dated: Name:       Title:       Address:       Address:       City, State, Zip:       Phone:       Fax:       E-Mail:       Attorney No.:       CERTIFICATE OF SERVICE I, ______________________________, do hereby certify that I have this day mailed, U.S. Mail, postage prepaid, a true and correct copy of the above and foregoing to __________________________________, at the following address; ___________________________________________________________________ THIS the ____ day of _____________, 20____. _________________________________ - 4 -