The plaintiff, complaining of the defendants, by his attorneys,
[ATTORNEY’S NAME], respectfully shows to this
Court and alleges:
FIRST: Upon information and belief, that at all times
hereinafter mentioned, the defendant [NAME OF
MUNICIPALITY] was and still is a municipal corporation
duly organized and existing under and by virtue of the laws
of the State of State of [NAME OF STATE].
SECOND: Upon information and belief, that at all times
hereinafter mentioned, the defendant [NAME OF
MUNICIPALITY], its agents, servants and employees
operated, maintained and controlled the Police Department
of the [NAME OF MUNICIPALITY], including all the
police officers thereof.
THIRD: Upon information and belief, that at all times
hereinafter mentioned, and on or prior to the [DATE OF
INCIDENT], [NAME OF OFFICER], was employed by
the defendant, [NAME OF MUNICIPALITY], as a police
officer.
FOURTH: That Notice of the Plaintiffs’ Claim and Notice
of Intention to Sue for Damages, the nature of the claim
and the date of, the time when, the place where and the
manner in which the claim arose was duly served upon
Comptroller of the defendant [NAME OF
MUNICIPALITY], on or about the [DATE NOTICE OF
CLAIM FILED].
FIFTH: That no hearing has been requested pursuant to
[NOTICE OF CLAIM LAW].
[OR, WHERE HEARING HELD]