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IN THE CIRCUIT COURT OF       COUNTY, MISSISSIPPI       , ADMINISTRATROR OF THE ESTATE OF       PLAINTIFF VS. NO.             , A MINOR, AND       DEFENDANTS COMPLAINT PLAINTIFFS REQUEST JURY TRIAL I. ACTION Comes the Plaintiff,       , Administrator of the Estate of       , Deceased, and files this suit for the wrongful death of       , Deceased, against the Defendants,       , a Minor, and       , and in support hereof, would show unto the Court the following facts, to - wit: 1.That the Plaintiff,       , Administrator of the Estate of       , is a resident citizen of       County, Mississippi, residing at       ,       , Mississippi,       . This suit is brought by the Administrator on behalf of himself/herself , as the natural mother/father ; his/her natural mother/father , brothers and sisters, pursuant to the Mississippi Wrongful Death statute, Section 11 - 7 - 13 of the Mississippi Code of 1972, as amended. The wrongful death beneficiaries of       are: a.       , Natural Mother,       ,       , Mississippi,       . b.       , Natural Father,       ,       ,       , Mississippi       . c.       ,       ,       , Mississippi       and       , brothers; d.       ,       ,       , Mississippi       and       ,       ,       , Mississippi       , sisters. 2. The Defendant,       , a minor, is a resident citizen of       County, Mississippi, on whom the process of this Court may be had by simultaneously serving him/her and serving his/her natural mother/father and legal guardian,       , at       ,       , Mississippi,       . 3. That the Defendant,       , is an adult resident citizen of       County, Mississippi, on whom the process of this Court may be had at       ,       , Mississippi,       . 4. That on             ,       , at a point on       in       County, Mississippi,       was severely, painfully and fatally injured as a direct and proximate result of the gross and reckless negligence of the defendant,       . Plaintiffs charge that the       automobile being driven by       in a       direction on       was struck head on by the             owned by the Defendant,       , and being driven by the Defendant,       , in a       direction on       . That at all times referred to herein and material hereto,       , was completely within his/her own lane of travel and on his/her side of the center of the       , which, at the point of the collision, was marked with a double yellow stripe center line. That the Defendant,       , while driving the said             at a highly dangerous and unlawful rate of speed, crossed over the solid yellow center line in his lane of travel, and into the lane of travel of       , causing a violent collision, which severely, painfully and fatally injured       . That the death of       and the damages proximately resulting there from were proximately caused by and proximately contributed to by the gross and reckless negligence of       . 5. Plaintiff charges that the Defendant,       , was negligent in the following particulars: a. He/She was driving at a rate of speed in excess of the posted speed limit of       miles per hour, as specified for traffic on       by Order of the Board of Supervisors of       County Mississippi, fixing the speed limit pursuant to Section 63 - 3 - 511 of the Mississippi Code of 1972. b. He/She drove his vehicle to the left of and across the solid yellow center stripe in his/her lane of travel, over into the lane of travel for       , so that he/she violated Section 63 - 3 - 601 and 63 - 3 - 607 of the Mississippi Code of 1972. c. He/She failed to yield the right of way to       who was traveling completely in his/her lane of travel when the Defendant crossed the centerline and into his/her lane of travel; d. He/She failed to keep and maintain a reasonable and proper lookout; center of the Road, which, at the point of the collision, was marked with a double yellow stripe centerline. That the Defendant,       , while driving the said             at a highly dangerous and unlawful rate of speed, crossed over the solid yellow center line in his/her lane of travel, and into the lane of travel of       , causing a violent collision, which severely, painfully and fatally injured       . That the death of       and the damages proximately resulting there from were proximately caused by and proximately contributed to by the gross and reckless negligence of       . 5. Plaintiff charges that the Defendant,       , was negligent in the following particulars: a. He/She was driving at a rate of speed in excess of the posted speed limit of 45 miles per hour, as specified for traffic on       by Order of the Board of Supervisors of       County, Mississippi, fixing the speed limit pursuant to Section 63 - 3 - 511 of the Mississippi Code of 1972. b. He/She drove his/her vehicle to the left of and across the solid yellow center stripe in his/her lane of travel, over into the lane of travel for       , so that he/she violated Section 63 - 3 - 601 and 63 - 3 - 607 of the Mississippi Code of 1972. c. He/She failed to yield the right of way to       who was traveling completely in his/her lane of travel when the Defendant crossed the centerline and into his/her lane of travel; d. He/She failed to keep and maintain a reasonable and proper lookout; e. He/She failed to have his/her vehicle under free, easy and proper control; f. He/She failed to slow the speed of his/her vehicle while traveling on a winding, curving roadway as required by Section 63 - 3 - 505 of the Mississippi Code of 1972; g. He/She was guilty of reckless driving as defined by Section 63 - 3 - 1201 of the Mississippi Code of 1972. That all of said negligence was gross and evinced a reckless disregard for the rights of other motorists and       , Deceased. That said negligence proximately caused and proximately contributed to the cause of the collision, Plaintiff's injuries, damages and death. 6. Plaintiff charges that the Defendant,       , is liable for the negligence of       while driving the       pickup truck owned by       and driven with his/her permission by the Defendant to       , pursuant to Section 63 - 1 - 23 and 63 - 1 - 25 of the Mississippi Code of 1972, by virtue of       having agreed, under said statutes and the signing of the said       application for Mississippi driver's license, to be jointly and severally liable for the negligence of       in the operation of vehicles until       reached the age of       (       ) years. That at the time of the wreck herein complained of,       was       (       ) years of age. That       is liable for the negligence of       which proximately caused and proximately contributed to the cause of the collision, the injuries and death of       , Deceased, and the damages proximately resulting there from. That at the time of his/her death,       , was       (       ) years of age and had a reasonable life expectancy of       years. That had he not been killed, he/she would have probably attained a college degree and worked to age       . That the net present cash value of the earnings lost as a result of his/her death is $       . That the loss of household services which       would have rendered to the Plaintiffs and his/her kindred during his/her life expectancy has a net present cash value of $       . That       enjoyed life to the fullest and the loss of enjoyment of life, which was eliminated by his/her death and the negligence of the Defendants has a value of at least $       per year, and a net present cash value of $       over his/her life expectancy. That the cost of his/her funeral and burial amounted to $       . That each of the survivors have been deprived of the love, society and companionship which each had of receiving from him/her had he/she not been killed. That       endured extreme conscious pain, suffering and mental anguish from the instant of impact until his/her death, which ensued within an hour after the collision. That all of said injuries and damages, and the damages of every kind and character allowed by Section 11 - 7 - 13 of the Mississippi Code of 1972, were proximately caused and proximately contributed to by the gross and reckless negligence of       , for which negligence of       , is jointly and severally liable. WHEREFORE , Plaintiff demands judgment against the Defendants, jointly and severally, in the sum of       ($       ) actual and punitive damages, together with prejudgment interest, post - judgment interest, and all costs of court to accrue in this cause. Respectfully submitted, ________________________________________       , ADMINISTRATROR OF THE ESTATE OF       , DECEASED BY: ______________________________       , His/Her Attorney

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