The form is a complaint for a default on payments due pursuant to a promissory note. The complaint adopts the "notice pleadings" format of the Federal Rules of Civil Procedure, which have been adopted by most states in one form or another.
This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.