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Assignment of Claim and Suit

In the State of Florida, the following form is used for the assignment of claim/suit.

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Extracted Text for Proper Search

ASSIGNMENT OF CLAIM/SUIT	 	
 
  For value received as required by section 320.781(7), Florida Statutes, I ______________ 
__________________________________ of  _________________________________________ 
Florida, assign and transfer to the State of Florida, Department of Highway Safety and Motor 
Vehicles, Mobile Home and Recreational Vehicle Protection Trust Fund, located at 2900 Apalachee 
Parkway, MS-60, Tallahassee, Florida 32399- 0600, as assignee, that claim initiated by me in my 
suit on ________________________________, against  ________________________________ 
_______________________, in the case entitled _ ___________________________________ v. 
______________________________ in the  ____________________________________ Federal 
Bankruptcy Court of  _________________________________, District of Florida, for the sum of  
___________________________________ Dollars ($                         ).  A copy of my claim is 
attached to this assignment.  
  This assignment is without recourse, and I do not guarantee recovery of this clai m hereby 
assigned.  However, I do agree that I will not release or discharge this claim, and that in the event 
any payment is made to me in response to this suit or claim, I will promptly transmit such payment 
to assignee.  
  I appoint my attorney in fact with power to demand and receive satisfaction of the claim, 
and, in my name, but at assignee’s expense, to take all lawful means for recovery of the sum due, 
and on payment to acknowledge satisfaction or discharge the claim or suit.  
  Dated _______________________ 
            _________________________________________ 
            Signature 
Sworn to or affirmed and subscribed  
Before me this  _____ day of 
__________________, 20____. 
 
________________________________  My Commission Expires: ____________________ 
NOTARY PUBLIC  
St ate of Florida at Large  
 
Personally Known ________________  Produced Identification ______________________ 
 
 
HSMV 84026 (Revised 09/13)
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