IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT 
IN AND FOR NASSAU COUNTY, FLORIDA

CASE NO.: _____________________________
DIVISION:  
____________________________,
                                                                  Plaintiff

____________________________,
				           Defendant

ANSWER 

	COMES NOW, the (  ) Plaintiff (    ) Defendant, _______________________________
in proper person, and therefore state:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____ [Please See Attached] 
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this motion and that the punishment for knowingly making a false statement includes fines and/or imprisonment.

Dated:  ___________________                              

Signature of Party

Name: 							
Address: 						
City, State, Zip: 					
Tel: ______________________________________
E-Mail: 						

STATE OF FLORIDA
COUNTY OF NASSAU                                         

Sworn to or affirmed and signed before me on                                by 	.

	
NOTARY PUBLIC or DEPUTY CLERK

	
[Print, type, or stamp commissioned name of notary or clerk.]

       	Personally known
       	Produced identification 
[___] Florida Driver’s License 		
[___] Florida Identification Card 	
Other Type of identification produced	_______________________________