Section 9-11-109. Form of complaint for negligence

                      IN THE            COURT OF            COUNTY                       
 
 
                               STATE OF GEORGIA                                

 
   A.B.,                           )
         Plaintiff                 )
 
                                   )
            v.                     )     Civil action
 
                                   )     File no.      
 
   C.D.,                           )     (Clerk will insert
         Defendant                 )     number.)
 
 
                                   COMPLAINT                                   

 
   The defendant C.D., herein named, is a resident of            (street),            
(city),            County, Georgia, and is subject to the jurisdiction of this 
court.
 
 
                                      1.                                       

 
   On June 1, 1966, on a public highway called Broad Street in Athens, 
Georgia, defendant negligently drove a motor vehicle against plaintiff who was 
then crossing said highway.
 
 
                                      2.                                       

 
   As a result plaintiff was thrown down and had his leg broken and was 
otherwise injured, was prevented from transacting his business, suffered great 
pain of body and mind, and incurred expenses for medical attention and 
hospitalization in the sum of $1,000.00.
 
   Wherefore, plaintiff demands judgment against defendant in the sum of 
$10,000.00 and costs.
 
                                                                               
 
                                                         Attorney for plaintiff
 
                                                                               
 
                                                                        Address

Ga. L. 1966, p. 609, § 109; Ga. L. 1980, p. 649, § 7.