Title 9, Chapter 11, Section 111
IN THE ________ COURT OF ________ COUNTY
STATE OF GEORGIA
v. ) Civil action
) File no. ______
C.D., ) (Clerk will insert
Defendant ) number.)
The defendant C.D., herein named, is a resident of
_______________________ (street), ________ (city), ________ County,
Georgia, and is subject to the jurisdiction of this court.
On or about December 1, 1966, defendant converted to his own use ten
bonds of the ______________ Company (here insert brief
identification as by number and issue) of the value of $10,000.00,
the property of plaintiff.
Wherefore, plaintiff demands judgment against defendant in the sum
of $10,000.00, interest, and costs.