GEORGIA STATUTES AND CODES
               		§ 9-11-118 - Form of complaint for interpleader and declaratory relief
               		
               		
               	 	
               	 	               	 	
               	 	
               	 	
               	 		
O.C.G.A.    9-11-118   (2010)
   9-11-118.    Form of complaint for interpleader and declaratory relief 
  
  
                                              IN  THE                    COURT  OF                    COUNTY                                                
  
  
                                                              STATE  OF  GEORGIA                                                                
  
  
  
  
  
      A.B.,                                              )
                  Plaintiff                          )
  
                                                              )
                        v.                                  )                  Civil  action
  
                                                              )                  File  no.          
  
      C.D.,  E.F.,  and  X.Y.,              )                  (Clerk  will  insert
                  Defendants                        )                  number.)
  
  
                                                                      COMPLAINT                                                                      
  
      The  defendant  C.D.,  herein  named,  is  a  resident  of                    (street),                    
(city),                    County,  Georgia,  and  is  subject  to  the  jurisdiction  of  this  
court.  (Add  appropriate  statement  about  domicile  of  remaining  defendants.)
  
  
                                                                            1.                                                                              
  
      On  or  about  June  1,  1965,  plaintiff  issued  to  G.H.  a  policy  of  life  
insurance  whereby  plaintiff  promised  to  pay  to  K.L.  as  beneficiary  the  sum  of  
$10,000.00  upon  the  death  of  G.H.  The  policy  required  the  payment  by  G.H.  of  a  
stipulated  premium  on  June  1,  1966,  and  annually  thereafter  as  a  condition  
precedent  to  its  continuance  in  force.
  
  
                                                                            2.                                                                              
  
      No  part  of  the  premium  due  June  1,  1966,  was  ever  paid  and  the  policy  
ceased  to  have  any  force  or  effect  after  July  1,  1966.
  
  
                                                                            3.                                                                              
  
      Thereafter,  on  September  1,  1966,  G.H.  and  K.L.  died  as  the  result  of  a  
collision  between  a  locomotive  and  the  automobile  in  which  G.H.  and  K.L.  were  
riding.
  
  
                                                                            4.                                                                              
  
      Defendant  C.D.  is  the  duly  appointed  and  acting  executor  of  the  will  of  
G.H.,  defendant  E.F.  is  the  duly  appointed  and  acting  executor  of  the  will  of  
K.L.,  and  defendant  X.Y.  claims  to  have  been  duly  designated  as  beneficiary  of  
said  policy  in  place  of  K.L.
  
  
                                                                            5.                                                                              
  
      Each  of  the  defendants,  C.D.,  E.F.,  and  X.Y.,  is  claiming  that  the  
above-mentioned  policy  was  in  full  force  and  effect  at  the  time  of  the  death  
of  G.H.;  each  of  them  is  claiming  to  be  the  only  person  entitled  to  receive  
payment  of  the  amount  of  the  policy  and  has  made  demand  for  payment  thereof.
  
  
                                                                            6.                                                                              
  
      By  reason  of  these  conflicting  claims  of  the  defendants,  plaintiff  is  in  
great  doubt  as  to  which  defendant  is  entitled  to  be  paid  the  amount  of  the  
policy  if  it  was  in  force  at  the  time  of  death  of  G.H.
  
      Wherefore,  plaintiff  demands  that  the  court  adjudge:
  
            (1)  That  none  of  the  defendants  is  entitled  to  recover  from  plaintiff  
the  amount  of  said  policy  or  any  part  thereof.
  
            (2)  That  each  of  the  defendants  be  restrained  from  instituting  any  
action  against  plaintiff  for  the  recovery  of  the  amount  of  said  policy  or  any  
part  thereof.
  
            (3)  That,  if  the  court  shall  determine  that  said  policy  was  in  force  at  
the  death  of  G.H.,  the  defendants  be  required  to  interplead  and  settle  between  
themselves  their  rights  to  the  money  due  under  said  policy  and  that  plaintiff  
be  discharged  from  all  liability  in  the  premises  except  to  the  person  whom  the  
court  shall  adjudge  entitled  to  the  amount  of  said  policy.
  
            (4)  That  plaintiff  recover  its  costs.
  
  
  
                                                                                                                                                              
                                                                                                                  Attorney  for  plaintiff
                                                                                                                                                              
                                                                                                                                                Address
               	 	
               	 	
               	 	               	 	
               	 	               	 	               	  
               	 
               	 
               	 
               	 
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