1. [Set forth a brief and concise statement of the facts giving rise to the conflicting claims of the defendants.]

2. By reason of these conflicting claims of the defendants, plaintiff is in doubt as to which defendant is entitled to be paid the amount alleged by the defendants to be due by the plaintiff.

Wherefore, the plaintiff demands that the court adjudge that the defendants be required to interplead and settle between themselves their rights to the moneys alleged by the defendants to be due by the plaintiff, and that plaintiff be discharged from all liability in the premises except to the person whom the court shall adjudge to be entitled to such amount.

_______________________,

Attorney for Plaintiff.

Address: _______________

Telephone: _____________