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Write a short and plain statement of the claim. Do not make legal arguments.This is an example of a completed statement of claim used to recover a debt. If you receive a statement of claim, this means that the plaintiff has started a court case against you to try to get their money or goods back. 333 - STATEMENT OF CLAIM (FOR MONEY LENT), Fla. To file suit, you must fill out a Statement of Claim and Notice form. (Write the full name of each plaintiff who is filing this complaint. You lent money to a friend, and he or she refuses to re-pay it. Done and Materials Furnished)); 7. 333 (Statement of Claim (For Money Lent));. 7.