Fill and Sign the Complaint for Impropriety Involving Loan Application Form

IN THE CIRCUIT COURT OF _____________ COUNTY, ____________ __________________________________ PLAINTIFF VS. CIVIL ACTION NO. _____________ __________________________________ DEFENDANT COMPLAINT ( Jury Trial Requested) COMES NOW the Plaintiff, _____________, hereinafter referred to as "Plaintiff," and files this, her Complaint, against the Defendant, ______________________, hereinafter referred to as "____________" and in support thereof, would show unto the Court the following matters and facts, to-wit: 1. The Plaintiff is an adult resident citizen of _____________ County, ____________ 2. The Defendant, is a legal entity organized and existing under the laws of the State of ____________ and may be served with process by serving its registered agent for process, __________________ at _______________, _______, _______________________. 3. On or about _________________ ______, 20____, Plaintiff signed an Application Statement with ____________________in order to help her _______ , ___________, purchase a_________________ (" _____ "). It was represented to her that she would be co-signing the promissory note along with her ______ , _______________, but the _____ would be in her said _____ 's name. While she did sign this application, some of the information was filled in by either ___________________, an agent and salesperson of Defendant and referred to hereafter as A Agent, @ and/or ______________, without Plaintiff = s knowledge or consent. Said information included Plaintiff = s home and work telephone numbers, her gross monthly salary, and some of the references. A copy of this Application is attached hereto as Exhibit A A. @ 1 4. Defendant, by its said agent and salesperson, did (or conspired to) fraudulently forge, sign, or otherwise use the name of another person (i.e. __________________) to the documents hereafter listed with intent to deceive, defraud, or for personal gain or benefit, or for the benefit of another person, without the express written or verbal approval of ______________ in violation of Section _________ of the ____________ Code of ______, as amended. Said documents were the following: a. Retail Installment Contract, a copy of which is attached hereto as Exhibit A B @ ; b. Odometer Disclosure Statement, a copy of which is attached hereto as Exhibit A C @ ; and c. Application for Certificate of Title with the State Tax Commission, a copy of which is attached hereto as Exhibit A D @ ; 4. ____________________ as the agent or employee of Defendant did perform or participate in all actions complained of herein, and at the time of said actions, ______________________was acting within the course and scope of that agency or employment. Said actions were the direct result of the failure by Defendant to adequately supervise and/or train said Agent. 5. The said conduct of Defendant, by its said agent and salesperson, constitutes a A pattern of racketeering activity @ pursuant to Subsections (a) (13) and (d) of Section __________ of the ____________ Code , and Plaintiff is entitled to threefold the actual damages sustained, punitive damages, attorneys = fees, and costs of litigation, in accordance with Subsection ___ of Section _____ of the ____________ Code. 6. As a direct and proximate result of the actions and negligence of Defendant as described above, Plaintiff suffered significant mental anguish. 2 WHEREFORE, PREMISES CONSIDERED , Plaintiff does hereby demand judgment against Defendant in the amount of $______________ regarding actual damages and $______________ in punitive damages, plus reasonable attorneys = fees and court costs. Respectfully submitted, _______________________________ ____ No. ______ ___________________________________ Attorney at law ___________________________________ ___________________________________ Telephone - ________________________ Telefax - ___________________________ 3